Healthcare Provider Details

I. General information

NPI: 1497891469
Provider Name (Legal Business Name): KENNETH WILLARD HILL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 SUMMAR AVE
JACKSON TN
38301
US

IV. Provider business mailing address

295 SUMMAR AVE
JACKSON TN
38301
US

V. Phone/Fax

Practice location:
  • Phone: 731-421-6764
  • Fax: 731-421-5148
Mailing address:
  • Phone: 731-421-6764
  • Fax: 731-421-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS2635
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: