Provider Demographics
NPI:1023416732
Name:JOSEPH M HILDEBRAND DDS PC
Entity type:Organization
Organization Name:JOSEPH M HILDEBRAND DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:HILDEBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:586-731-9050
Mailing Address - Street 1:45424 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:MI
Mailing Address - Zip Code:48317-5676
Mailing Address - Country:US
Mailing Address - Phone:586-731-9050
Mailing Address - Fax:586-731-9056
Practice Address - Street 1:45424 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:MI
Practice Address - Zip Code:48317-5676
Practice Address - Country:US
Practice Address - Phone:586-731-9050
Practice Address - Fax:586-731-9056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010135631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T96879Medicare UPIN