Provider Demographics
NPI:1841508090
Name:HILT, BRUCE ROBERT I (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ROBERT
Last Name:HILT
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3314 SUPERIOR AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1860
Mailing Address - Country:US
Mailing Address - Phone:920-452-9550
Mailing Address - Fax:920-452-9292
Practice Address - Street 1:3314 SUPERIOR AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-1860
Practice Address - Country:US
Practice Address - Phone:920-452-9550
Practice Address - Fax:920-452-9292
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5520-015122300000X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist