Healthcare Provider Details

I. General information

NPI: 1982674214
Provider Name (Legal Business Name): JEFFREY WILLIAM HILLEY D.M.D., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 06/13/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 MASSEY AVE
NS MAYPORT FL
32228
US

IV. Provider business mailing address

404 BIG TREE RD
PONTE VEDRA BEACH FL
32082-4139
US

V. Phone/Fax

Practice location:
  • Phone: 904-270-4460
  • Fax:
Mailing address:
  • Phone: 770-853-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD 6367 C
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD 6367 C
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 013101
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number26637
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN013101
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: