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General NPI Number Information
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NPI Number | 1275048449
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Entity Type | Organization
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Legal Business Name | ELMER E HILO II DMD, INC
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 12/08/2017
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Provider Practice Location Address
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Address Line | 404 S PROSPECTORS RD STE B
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1617
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Country | US
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Telephone | 909-276-4404
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Fax | 909-354-3156
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Provider Business Mailing Address
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Address Line | 404 S PROSPECTORS RD STE B
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City | DIAMOND BAR
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State | CA
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Zip | 91765-1617
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Country | US
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Telephone | 909-276-4404
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Fax | 909-354-3156
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELMER ENERIO HILO II
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Credential | DMD
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Telephone | 909-276-4404
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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 | 63886
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License Number State | CA
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