Provider Demographics
NPI:1427066349
Name:HILL, GARY PREVOST (DDS MS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:PREVOST
Last Name:HILL
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3115 ACADEMY ROAD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707
Mailing Address - Country:US
Mailing Address - Phone:919-493-2569
Mailing Address - Fax:919-493-5437
Practice Address - Street 1:3115 ACADEMY ROAD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707
Practice Address - Country:US
Practice Address - Phone:919-493-2569
Practice Address - Fax:919-493-5437
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993898Medicaid
93898OtherBLUE CROSS BLUE SHIELD
93898OtherBLUE CROSS BLUE SHIELD