Healthcare Provider Details

I. General information

NPI: 1790867505
Provider Name (Legal Business Name): JOHN EARL HILTON JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 E MAIN ST SUITE A
RADFORD VA
24141-1761
US

IV. Provider business mailing address

1151 E MAIN ST SUITE A
RADFORD VA
24141-1761
US

V. Phone/Fax

Practice location:
  • Phone: 540-639-1674
  • Fax: 540-639-9205
Mailing address:
  • Phone: 540-639-1674
  • Fax: 540-639-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401003966
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: