Provider Demographics
NPI:1902947427
Name:HILL, KENNETH EARLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EARLE
Last Name:HILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W HORIZON RIDGE PKWY
Mailing Address - Street 2:SUITE S
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-3600
Mailing Address - Country:US
Mailing Address - Phone:702-897-7267
Mailing Address - Fax:702-992-4057
Practice Address - Street 1:1550 W HORIZON RIDGE PKWY
Practice Address - Street 2:SUITE S
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-3600
Practice Address - Country:US
Practice Address - Phone:702-897-7267
Practice Address - Fax:702-992-4057
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV45511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice