Provider Demographics
NPI:1184770919
Name:HILL, ROGER W (DDS, MS, PC)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:W
Last Name:HILL
Suffix:
Gender:M
Credentials:DDS, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 WASHINGTON AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5765
Mailing Address - Country:US
Mailing Address - Phone:989-892-0440
Mailing Address - Fax:989-892-8490
Practice Address - Street 1:916 WASHINGTON AVE STE 230
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5765
Practice Address - Country:US
Practice Address - Phone:989-892-0440
Practice Address - Fax:989-892-8490
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010098441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics