Healthcare Provider Details

I. General information

NPI: 1982672309
Provider Name (Legal Business Name): EDWARD E HILL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N. STATE ST.
JACKSON MS
39216-4505
US

IV. Provider business mailing address

108 SAVOY PARK
MADISON MS
39110
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-6030
  • Fax:
Mailing address:
  • Phone: 601-607-7229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberPROS-392-05
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: