Provider Demographics
NPI:1821292210
Name:O. JERRY HILL, JR. DDS, PA
Entity Type:Organization
Organization Name:O. JERRY HILL, JR. DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OREN
Authorized Official - Middle Name:JERRY
Authorized Official - Last Name:HILL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-873-0263
Mailing Address - Street 1:925 THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3484
Mailing Address - Country:US
Mailing Address - Phone:704-873-0263
Mailing Address - Fax:704-873-1813
Practice Address - Street 1:925 THOMAS ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3484
Practice Address - Country:US
Practice Address - Phone:704-873-0263
Practice Address - Fax:704-873-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42051223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC241074OtherMDCRPIN
NC8993902Medicaid
NCU63810Medicare UPIN
NC8993902Medicaid
NC241074Medicare PIN