Healthcare Provider Details

I. General information

NPI: 1669665410
Provider Name (Legal Business Name): GARY P HILL DDS MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 ACADEMY ROAD
DURHAM NC
27707
US

IV. Provider business mailing address

3115 ACADEMY ROAD
DURHAM NC
27707
US

V. Phone/Fax

Practice location:
  • Phone: 919-493-2569
  • Fax: 919-493-5437
Mailing address:
  • Phone: 919-493-2569
  • Fax: 919-493-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number3679
License Number StateNC

VIII. Authorized Official

Name: DR. GARY P HILL
Title or Position: OWNER
Credential: DDS MS
Phone: 919-493-2569