Provider Demographics
NPI:1699268730
Name:HILL FAMILY DENTAL, PLLC
Entity type:Organization
Organization Name:HILL FAMILY DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAVALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-225-7110
Mailing Address - Street 1:205 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-4745
Mailing Address - Country:US
Mailing Address - Phone:801-225-7110
Mailing Address - Fax:
Practice Address - Street 1:205 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-4745
Practice Address - Country:US
Practice Address - Phone:801-225-7110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-13
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1215985759Medicaid