MEDICARE: HILL DENTAL ACQUISITIONS, LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1508574906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HILL DENTAL ACQUISITIONS, LLC

Provider Business Mailing Address
First Line	:	4374 MCPHERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-2706
Country	:	US
Telephone Number	:	314-707-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1034 S BRENTWOOD BLVD STE 790
Second Line	:
City	:	RICHMOND HEIGHTS
State	:	MO
Zip	:	63117-1271
Country	:	US
Telephone Number	:	314-678-7876
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	CORINNE HILL
Credential	:
Telephone Number	:	314-707-0650

Provider Enumeration Date	:	11/14/2022
Last Update Date	:	11/14/2022

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