Healthcare Provider Details

I. General information

NPI: 1255242061
Provider Name (Legal Business Name): SALLY HILKERT RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 LANSFORD CT
MYRTLE BEACH SC
29588-3501
US

IV. Provider business mailing address

114 ASHLEY PARK DR UNIT 101
MYRTLE BEACH SC
29579-2741
US

V. Phone/Fax

Practice location:
  • Phone: 854-600-1540
  • Fax:
Mailing address:
  • Phone: 567-207-6626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number12551
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: