Provider Demographics
NPI:1144704206
Name:HILTON, DONALD JACOB (DDS)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:JACOB
Last Name:HILTON
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 1:213 W CIVIC CENTER DR APT 117
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-1222
Mailing Address - Country:US
Mailing Address - Phone:210-573-1503
Mailing Address - Fax:
Practice Address - Street 1:2114 S HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-2807
Practice Address - Country:US
Practice Address - Phone:210-573-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10936821-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice