Provider Demographics
NPI:1851465678
Name:HILL, CAROLYN JO (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:JO
Last Name:HILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30630 RANCHO CALIFORNIA RD
Mailing Address - Street 2:SUITE 504
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3283
Mailing Address - Country:US
Mailing Address - Phone:951-694-0545
Mailing Address - Fax:951-694-5654
Practice Address - Street 1:30630 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE 504
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3283
Practice Address - Country:US
Practice Address - Phone:951-694-0545
Practice Address - Fax:951-694-5654
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2015-05-21
Deactivation Date:2012-08-24
Deactivation Code:
Reactivation Date:2015-05-21
Provider Licenses
StateLicense IDTaxonomies
CA28164122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist