Provider Demographics
NPI:1952673790
Name:HILSABECK, RICHARD B (DDS)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:B
Last Name:HILSABECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 APPLE CREEK COURT
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8357
Mailing Address - Country:US
Mailing Address - Phone:920-739-6954
Mailing Address - Fax:920-739-6954
Practice Address - Street 1:9 TRI PARK WAY
Practice Address - Street 2:TRI-COUNTY COMMUNITY DENTAL CLINIC
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54914
Practice Address - Country:US
Practice Address - Phone:920-882-8508
Practice Address - Fax:920-882-9961
Is Sole Proprietor?:No
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001588-151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery