Healthcare Provider Details

I. General information

NPI: 1073636122
Provider Name (Legal Business Name): RULON B. HILLAM DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 WADSWORTH PKWY
WESTMINSTER CO
80021-6847
US

IV. Provider business mailing address

9920 WADSWORTH PKWY
WESTMINSTER CO
80021-6847
US

V. Phone/Fax

Practice location:
  • Phone: 801-369-0647
  • Fax: 801-375-0397
Mailing address:
  • Phone: 801-369-0647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5685033-9922
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6758
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00202407
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1410
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN-DEN-LIC-7792
License Number StateMT
# 6
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number31825
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: