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General NPI Number Information
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NPI Number | 1043594930
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Entity Type | Organization
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Legal Business Name | HILSEN DDS LLC
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 12/06/2013
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Provider Practice Location Address
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Address Line | 721 TEANECK RD
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City | TEANECK
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State | NJ
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Zip | 07666-4249
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Country | US
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Telephone | 201-833-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 721 TEANECK RD
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City | TEANECK
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State | NJ
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Zip | 07666-4249
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Country | US
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Telephone | 201-833-7260
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH LEE HILSEN
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Credential | DDS
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Telephone | 201-785-1068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22DI00961800
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License Number State | NJ
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