Healthcare Provider Details

I. General information

NPI: 1912831991
Provider Name (Legal Business Name): DYLAN M HILDEBRAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 COLLEGE AVE
ALTON IL
62002-4700
US

IV. Provider business mailing address

977 N BRIEGEL ST
COLUMBIA IL
62236-1311
US

V. Phone/Fax

Practice location:
  • Phone: 618-474-7000
  • Fax:
Mailing address:
  • Phone: 618-910-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019.037182
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: