Healthcare Provider Details

I. General information

NPI: 1750360004
Provider Name (Legal Business Name): ANDREW C HILLE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2006
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S SOUTHEASTERN AVE
SIOUX FALLS SD
57103-3227
US

IV. Provider business mailing address

1700 S SOUTHEASTERN AVE
SIOUX FALLS SD
57103-3227
US

V. Phone/Fax

Practice location:
  • Phone: 605-331-5059
  • Fax: 605-275-6725
Mailing address:
  • Phone: 605-331-5059
  • Fax: 605-275-6725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberS0401
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: