Provider Demographics
NPI:1396800033
Name:BERRY, HILLARY ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:HILLARY
Middle Name:ANNE
Last Name:BERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HILLARY
Other - Middle Name:ANNE
Other - Last Name:CROMWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1387
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1387
Mailing Address - Country:US
Mailing Address - Phone:208-415-0299
Mailing Address - Fax:208-325-2070
Practice Address - Street 1:109 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:KELLOGG
Practice Address - State:ID
Practice Address - Zip Code:83837-2501
Practice Address - Country:US
Practice Address - Phone:208-784-0545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD83011223G0001X, 1223G0001X
IDD49431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice