Provider Demographics
NPI:1700950243
Name:HILL, CHARLES K (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:K
Last Name:HILL
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9777 BERMUDA RD
Mailing Address - Street 2:STE. 105
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-3566
Mailing Address - Country:US
Mailing Address - Phone:702-914-2364
Mailing Address - Fax:702-914-2365
Practice Address - Street 1:9777 BERMUDA RD
Practice Address - Street 2:STE. 105
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89183-3566
Practice Address - Country:US
Practice Address - Phone:702-914-2364
Practice Address - Fax:702-914-2365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4331122300000X
NVS3-2551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505926Medicaid