Healthcare Provider Details

I. General information

NPI: 1992982235
Provider Name (Legal Business Name): ROBERT A HILLER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2008
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 N MAIN ST SUITE 1
RUTLAND VT
05701
US

IV. Provider business mailing address

135 N MAIN ST SUITE 1
RUTLAND VT
05701
US

V. Phone/Fax

Practice location:
  • Phone: 802-770-1730
  • Fax: 802-770-1734
Mailing address:
  • Phone: 802-770-1730
  • Fax: 802-770-1734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0160000517
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0160000517
License Number StateVT

VIII. Authorized Official

Name: DR. ROBERT A HILLER
Title or Position: DENTIST
Credential: DMD
Phone: 802-770-1730