Provider Demographics
NPI:1972061539
Name:HILLEY, MARY (ND)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:HILLEY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 GENERAL SAGE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6397
Mailing Address - Country:US
Mailing Address - Phone:505-428-0091
Mailing Address - Fax:
Practice Address - Street 1:33 GENERAL SAGE DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6397
Practice Address - Country:US
Practice Address - Phone:505-428-0091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-03
Last Update Date:2019-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM654124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist