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General NPI Number Information
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NPI Number | 1417355082
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Entity Type | Organization
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Legal Business Name | INGLESIDE DENTISTRY
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 2681 STATE HIGHWAY 361
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City | INGLESIDE
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State | TX
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Zip | 78362-4200
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Country | US
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Telephone | 361-776-3535
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Fax | 866-766-2629
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Provider Business Mailing Address
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Address Line | 2681 STATE HIGHWAY 361
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City | INGLESIDE
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State | TX
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Zip | 78362-4200
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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 | DENTIST/OWNER
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Name | DR. TIM G. HILL
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Credential |
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Telephone | 361-776-3535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30072
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License Number State | TX
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