MEDICARE: DR. RONALD ROBERT HILDER 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	32441	CA

General Provider Information

NPI Number	:	1801947353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD ROBERT HILDER D.D.S.

Provider Business Mailing Address
First Line	:	425 PINE ST
Second Line	:	SUITE 3
City	:	GALT
State	:	CA
Zip	:	95632-2055
Country	:	US
Telephone Number	:	209-745-4607
Fax Number	:	209-745-4636

Provider Business Practice Location Address
First Line	:	425 PINE ST
Second Line	:	SUITE 3
City	:	GALT
State	:	CA
Zip	:	95632-2055
Country	:	US
Telephone Number	:	209-745-4607
Fax Number	:	209-745-4636

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

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	07/08/2007

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