Healthcare Provider Details

I. General information

NPI: 1720004518
Provider Name (Legal Business Name): O JERRY HILL JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 THOMAS ST
STATESVILLE NC
28677-3484
US

IV. Provider business mailing address

925 THOMAS ST
STATESVILLE NC
28677-3484
US

V. Phone/Fax

Practice location:
  • Phone: 704-873-0263
  • Fax: 704-873-1813
Mailing address:
  • Phone: 704-873-0263
  • Fax: 704-873-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberNC4205
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: