Provider Demographics
NPI:1588407357
Name:HILL, MADELINE WHITE
Entity type:Individual
Prefix:
First Name:MADELINE
Middle Name:WHITE
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 GRAY HAWK RD APT C
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-7011
Mailing Address - Country:US
Mailing Address - Phone:859-699-6851
Mailing Address - Fax:
Practice Address - Street 1:1312 GRAY HAWK RD APT C
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-7011
Practice Address - Country:US
Practice Address - Phone:859-699-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111311223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral Practice