Provider Demographics
NPI:1730458357
Name:MICHAEL HILLEARY DDS PLLC
Entity type:Organization
Organization Name:MICHAEL HILLEARY DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HILLEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-296-1721
Mailing Address - Street 1:157 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTOVER
Mailing Address - State:WV
Mailing Address - Zip Code:26501-4315
Mailing Address - Country:US
Mailing Address - Phone:304-296-1721
Mailing Address - Fax:304-296-1115
Practice Address - Street 1:157 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:WESTOVER
Practice Address - State:WV
Practice Address - Zip Code:26501-4315
Practice Address - Country:US
Practice Address - Phone:304-296-1721
Practice Address - Fax:304-296-1115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-28
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV36401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty