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General NPI Number Information
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NPI Number | 1225193691
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Entity Type | Individual
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Provider Name | AGNES DIZON HILL D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/30/2023
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Provider Practice Location Address
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Address Line | 1665 UTICA AVE S STE 100
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City | ST LOUIS PARK
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State | MN
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Zip | 55416-3476
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Country | US
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Telephone | 952-541-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 7333 DREW AVE N
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City | BROOKLYN PARK
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State | MN
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Zip | 55443-3537
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D12339
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D12339
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License Number State | MN
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