Provider Demographics
NPI:1912414046
Name:HILLSTREAM DENTAL PARTNERS L.L.C.
Entity type:Organization
Organization Name:HILLSTREAM DENTAL PARTNERS L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-853-9400
Mailing Address - Street 1:2565 S. ROCHESTER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-853-9400
Mailing Address - Fax:243-853-8455
Practice Address - Street 1:2565 S. ROCHESTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307
Practice Address - Country:US
Practice Address - Phone:248-853-9400
Practice Address - Fax:243-853-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-10
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012903122300000X
MI2901020209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty