Provider Demographics
NPI:1881421154
Name:HILL, KATIE (RDH)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:HILL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:TIBBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 NEEDLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8193
Mailing Address - Country:US
Mailing Address - Phone:616-799-3945
Mailing Address - Fax:
Practice Address - Street 1:781 36TH ST SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-2319
Practice Address - Country:US
Practice Address - Phone:616-828-0052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902016325124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist