Healthcare Provider Details

I. General information

NPI: 1376573840
Provider Name (Legal Business Name): SAMUEL LANE HILL II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 EAST AVENUE
NAPOLEON MI
49261
US

IV. Provider business mailing address

8327 ODOWLING
ONSTED MI
49265-9489
US

V. Phone/Fax

Practice location:
  • Phone: 517-536-8641
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9751
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: