MEDICARE: KIELA MARIE HILTON D.D.S.

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	122300000X	Dentist	19389	TX

General Provider Information

NPI Number	:	1659380905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIELA MARIE HILTON D.D.S.

Provider Business Mailing Address
First Line	:	18724 HELOTES RDG
Second Line	:
City	:	HELOTES
State	:	TX
Zip	:	78023-2855
Country	:	US
Telephone Number	:	210-695-5156
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 SW LOOP 410
Second Line	:	SUITE139B
City	:	SAN ANTONIO
State	:	TX
Zip	:	78227-1664
Country	:	US
Telephone Number	:	210-675-9200
Fax Number	:	210-675-9204

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	07/08/2007

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