Provider Demographics
NPI:1649447855
Name:HILTY, JACK B (DDS)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:B
Last Name:HILTY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COOPER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-3630
Mailing Address - Country:US
Mailing Address - Phone:970-945-1185
Mailing Address - Fax:970-945-4827
Practice Address - Street 1:900 COOPER AVE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3630
Practice Address - Country:US
Practice Address - Phone:970-945-1185
Practice Address - Fax:970-945-4827
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-057051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics