Provider Demographics
NPI:1124292602
Name:JOHN L HILLSMAN DDS PA
Entity type:Organization
Organization Name:JOHN L HILLSMAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HILLSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:828-669-7205
Mailing Address - Street 1:997 OLD US 70
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-2941
Mailing Address - Country:US
Mailing Address - Phone:828-669-7205
Mailing Address - Fax:828-669-1804
Practice Address - Street 1:997 OLD US 70
Practice Address - Street 2:SUITE C
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711-2941
Practice Address - Country:US
Practice Address - Phone:828-669-7205
Practice Address - Fax:828-669-1804
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN L HILLSMAN DDS PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC27831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty