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General NPI Number Information
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NPI Number | 1306973862
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Entity Type | Organization
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Legal Business Name | RODNEY H HILLAM DDS MS PA
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3325 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 206-524-1800
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Fax | 208-524-1890
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Provider Business Mailing Address
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Address Line | 3325 S HOLMES AVE
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7981
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Country | US
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Telephone | 206-524-1800
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Fax | 208-524-1890
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | RODNEY H HILLAM
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Credential | DDS MS PA
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Telephone | 208-524-1800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 918
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License Number State | WY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 2019
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License Number State | ID
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