Provider Demographics
NPI:1992982235
Name:ROBERT A HILLER LTD
Entity type:Organization
Organization Name:ROBERT A HILLER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:802-770-1730
Mailing Address - Street 1:135 N MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05701
Mailing Address - Country:US
Mailing Address - Phone:802-770-1730
Mailing Address - Fax:802-770-1734
Practice Address - Street 1:135 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701
Practice Address - Country:US
Practice Address - Phone:802-770-1730
Practice Address - Fax:802-770-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160000517122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTD001588Medicaid