Provider Demographics
NPI:1013047158
Name:HILLER, MICHAEL E (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:HILLER
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 1:4607 SHERWOOD COMMON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816
Mailing Address - Country:US
Mailing Address - Phone:225-924-7367
Mailing Address - Fax:225-929-9506
Practice Address - Street 1:4607 SHERWOOD COMMON BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816
Practice Address - Country:US
Practice Address - Phone:225-924-7367
Practice Address - Fax:225-929-9506
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA42841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics