Provider Demographics
NPI:1386757276
Name:HILLIS, DANIEL SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:SCOTT
Last Name:HILLIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6499 S MASON MONTGOMERY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1764
Mailing Address - Country:US
Mailing Address - Phone:513-336-8510
Mailing Address - Fax:513-336-7359
Practice Address - Street 1:6499 S MASON MONTGOMERY RD
Practice Address - Street 2:SUITE B
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1764
Practice Address - Country:US
Practice Address - Phone:513-336-8510
Practice Address - Fax:513-336-7359
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH214511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice