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General NPI Number Information
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NPI Number | 1376945550
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Entity Type | Organization
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Legal Business Name | GREGORY A HILLYARD DMD PC
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 47 STATE RD
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City | MEDIA
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State | PA
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Zip | 19063-1544
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Country | US
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Telephone | 610-566-0291
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Fax |
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Provider Business Mailing Address
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Address Line | 47 STATE RD
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City | MEDIA
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State | PA
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Zip | 19063-1544
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Country | US
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Telephone | 610-566-0291
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE
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Name | DR. ALEXANDRA H MONROE
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Credential | D.M.D.
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Telephone | 610-566-0291
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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 | 50 057464
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DS039904
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License Number State | PA
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