Healthcare Provider Details

I. General information

NPI: 1023416732
Provider Name (Legal Business Name): JOSEPH M HILDEBRAND DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2014
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45424 VAN DYKE AVE
UTICA MI
48317-5676
US

IV. Provider business mailing address

45424 VAN DYKE AVE
UTICA MI
48317-5676
US

V. Phone/Fax

Practice location:
  • Phone: 586-731-9050
  • Fax: 586-731-9056
Mailing address:
  • Phone: 586-731-9050
  • Fax: 586-731-9056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2901013563
License Number StateMI

VIII. Authorized Official

Name: DR. JOSEPH M HILDEBRAND
Title or Position: OWNER
Credential: DDS
Phone: 586-731-9050