Provider Demographics
NPI:1750421210
Name:HILL COUNTRY DENTAL ASSOCIATES, PA
Entity type:Organization
Organization Name:HILL COUNTRY DENTAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JINKINS
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-257-7444
Mailing Address - Street 1:715 HILL COUNTRY DR
Mailing Address - Street 2:STE. 5
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-5965
Mailing Address - Country:US
Mailing Address - Phone:830-257-7444
Mailing Address - Fax:830-896-7977
Practice Address - Street 1:715 HILL COUNTRY DR
Practice Address - Street 2:STE. 5
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5965
Practice Address - Country:US
Practice Address - Phone:830-257-7444
Practice Address - Fax:830-896-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty