Provider Demographics
NPI:1841404647
Name:THOMAS A. HILLEBRAND, DMD, PA
Entity Type:Organization
Organization Name:THOMAS A. HILLEBRAND, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILLEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, PA
Authorized Official - Phone:603-542-8797
Mailing Address - Street 1:110 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-5615
Mailing Address - Country:US
Mailing Address - Phone:603-542-8797
Mailing Address - Fax:603-542-6901
Practice Address - Street 1:110 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-5615
Practice Address - Country:US
Practice Address - Phone:603-542-8797
Practice Address - Fax:603-542-6901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1410204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0001893Medicaid
NH89191893Medicaid
NH89191893Medicaid