=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841272754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH M HILDEBRAND DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2005
-----------------------------------------------------
Last Update Date | 07/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 50154 SCHOENHERR RD
-----------------------------------------------------
City | SHELBY TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48315-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-731-9050
-----------------------------------------------------
Fax | 586-731-9056
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50154 SCHOENHERR RD
-----------------------------------------------------
City | SHELBY TOWNSHIP
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48315-3136
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 586-731-9050
-----------------------------------------------------
Fax | 586-731-9056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223S0112X
-----------------------------------------------------
Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
-----------------------------------------------------
License Number | 2901013563
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------