=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508574906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILL DENTAL ACQUISITIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2022
-----------------------------------------------------
Last Update Date | 11/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1034 S BRENTWOOD BLVD STE 790
-----------------------------------------------------
City | RICHMOND HEIGHTS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63117-1271
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-678-7876
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4374 MCPHERSON AVE
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63108-2706
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-707-0650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | CORINNE HILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 314-707-0650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------