Healthcare Provider Details

I. General information

NPI: 1710154380
Provider Name (Legal Business Name): RANDALL SCOTT HILTNER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 CHAPEL HILL BLVD SUITE 301
DURHAM NC
27707-6235
US

IV. Provider business mailing address

3325 CHAPEL HILL BLVD SUITE 301
DURHAM NC
27707-6235
US

V. Phone/Fax

Practice location:
  • Phone: 919-489-1316
  • Fax: 919-493-1400
Mailing address:
  • Phone: 919-489-1316
  • Fax: 919-493-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7287
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: