Provider Demographics
NPI:1972988848
Name:MYRNA GRACE S.HILO, DMD, INC
Entity type:Organization
Organization Name:MYRNA GRACE S.HILO, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRNA GRACE
Authorized Official - Middle Name:SERRANO
Authorized Official - Last Name:HILO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-727-0722
Mailing Address - Street 1:4767 LAFAYETTE ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1600
Mailing Address - Country:US
Mailing Address - Phone:408-727-0722
Mailing Address - Fax:
Practice Address - Street 1:4767 LAFAYETTE ST STE 104
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1600
Practice Address - Country:US
Practice Address - Phone:408-727-0722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB40610261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental