Provider Demographics
NPI:1700958477
Name:HILL, DAVID J (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
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 1:17410 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-2782
Mailing Address - Country:US
Mailing Address - Phone:313-863-7805
Mailing Address - Fax:517-783-9858
Practice Address - Street 1:123 N WEST AVE
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1926
Practice Address - Country:US
Practice Address - Phone:517-784-0038
Practice Address - Fax:517-783-9858
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID148621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1869334Medicaid