Provider Demographics
NPI:1962521765
Name:HILLMAN, BONNIE K, (DDS)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:K,
Last Name:HILLMAN
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 1:2400 BALFOUR RD
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-4945
Mailing Address - Country:US
Mailing Address - Phone:925-516-4107
Mailing Address - Fax:
Practice Address - Street 1:2400 BALFOUR RD
Practice Address - Street 2:SUITE 309
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-4945
Practice Address - Country:US
Practice Address - Phone:925-516-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-2828803OtherTIN