Provider Demographics
NPI:1316145634
Name:HILGERS PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:HILGERS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:HILGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:623-536-0079
Mailing Address - Street 1:14425 W MCDOWELL RD
Mailing Address - Street 2:SUITE F 102
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2516
Mailing Address - Country:US
Mailing Address - Phone:623-536-0079
Mailing Address - Fax:623-535-5176
Practice Address - Street 1:14425 W MCDOWELL RD
Practice Address - Street 2:SUITE F 102
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2516
Practice Address - Country:US
Practice Address - Phone:623-536-0079
Practice Address - Fax:623-535-5176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-08
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ66931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty