Provider Demographics
NPI:1548368681
Name:HILLEBRAND, THOMAS A (DMD PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:HILLEBRAND
Suffix:
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHARLESTOWN ROAD
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-5615
Mailing Address - Country:US
Mailing Address - Phone:603-542-8797
Mailing Address - Fax:603-542-6901
Practice Address - Street 1:110 CHARLESTOWN ROAD
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-5615
Practice Address - Country:US
Practice Address - Phone:603-542-8797
Practice Address - Fax:603-542-6901
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1410204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0001893Medicaid
NH89191893Medicaid
NH89191893Medicaid