MEDICARE: DONALD JACOB HILTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	10936821-9921	UT

General Provider Information

NPI Number	:	1144704206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD JACOB HILTON DDS

Provider Business Mailing Address
First Line	:	213 W CIVIC CENTER DR APT 117
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-1222
Country	:	US
Telephone Number	:	210-573-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 S HIGHLAND DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84106-2807
Country	:	US
Telephone Number	:	210-573-1503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2018
Last Update Date	:	09/24/2018

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