Healthcare Provider Details

I. General information

NPI: 1396654091
Provider Name (Legal Business Name): HILLSTEAD FAMILY ORTHODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 E 12450 S STE 202
DRAPER UT
84020-8060
US

IV. Provider business mailing address

114 E 12450 S STE 202
DRAPER UT
84020-8060
US

V. Phone/Fax

Practice location:
  • Phone: 480-528-0937
  • Fax:
Mailing address:
  • Phone: 480-528-0937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW BLAKE HILLSTEAD
Title or Position: OWNER/ORTHODONTIST
Credential: DDS
Phone: 480-528-0937