Provider Demographics
NPI:1376945550
Name:GREGORY A HILLYARD DMD PC
Entity type:Organization
Organization Name:GREGORY A HILLYARD DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:H
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-566-0291
Mailing Address - Street 1:47 STATE RD
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1544
Mailing Address - Country:US
Mailing Address - Phone:610-566-0291
Mailing Address - Fax:
Practice Address - Street 1:47 STATE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1544
Practice Address - Country:US
Practice Address - Phone:610-566-0291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50 057464261QD0000X
PADS039904261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental