Provider Demographics
NPI:1205042686
Name:HILLSIDE DENTAL ASSOCIATES
Entity type:Organization
Organization Name:HILLSIDE DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:SCOVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-776-8441
Mailing Address - Street 1:644 N MAIN STREET
Mailing Address - Street 2:#101
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-3238
Mailing Address - Country:US
Mailing Address - Phone:801-776-8441
Mailing Address - Fax:801-776-8428
Practice Address - Street 1:466 N MAIN ST
Practice Address - Street 2:#101
Practice Address - City:CLEARFIELD
Practice Address - State:UT
Practice Address - Zip Code:84015-3222
Practice Address - Country:US
Practice Address - Phone:801-776-8441
Practice Address - Fax:801-776-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4974568-01601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty