Provider Demographics
NPI:1427442490
Name:HILL FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:HILL FAMILY DENTISTRY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-558-8127
Mailing Address - Street 1:36359 N GANTZEL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN TAN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85140-7331
Mailing Address - Country:US
Mailing Address - Phone:480-588-8127
Mailing Address - Fax:866-496-3932
Practice Address - Street 1:36359 N GANTZEL RD
Practice Address - Street 2:STE 101
Practice Address - City:SAN TAN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85140-7331
Practice Address - Country:US
Practice Address - Phone:480-588-8127
Practice Address - Fax:866-496-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-26
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD075651223G0001X
AZD0091591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty