Provider Demographics
NPI:1811945348
Name:HILDAHL, BYRON THEODORE (DDS)
Entity type:Individual
Prefix:
First Name:BYRON
Middle Name:THEODORE
Last Name:HILDAHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 W FRANCIS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6401
Mailing Address - Country:US
Mailing Address - Phone:509-327-3368
Mailing Address - Fax:509-325-2712
Practice Address - Street 1:707 W FRANCIS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-6401
Practice Address - Country:US
Practice Address - Phone:509-327-3368
Practice Address - Fax:509-325-2712
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3517OtherDELTA PROVIDER NUMBER
WA136630OtherBCBS PROVIDER NUMBER
WA804444OtherUNITED CON. PROVIDER NUM.
WA5012059Medicaid