Provider Demographics
NPI:1134206766
Name:HILL, TIMOTHY N (DMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:N
Last Name:HILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3111
Mailing Address - Country:US
Mailing Address - Phone:719-562-4461
Mailing Address - Fax:719-584-7694
Practice Address - Street 1:3362 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-6442
Practice Address - Country:US
Practice Address - Phone:775-329-5437
Practice Address - Fax:775-829-1553
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV5510OtherNV LICENSE