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General NPI Number Information
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NPI Number | 1952001687
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Entity Type | Individual
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Provider Name | BERTHA ELIZABETH HILLIAN
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Gender | Female
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Dates
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Enumeration Date | 03/10/2023
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 109 GAINSBOROUGH SQ
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City | CHESAPEAKE
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State | VA
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Zip | 23320-1707
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Country | US
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Telephone | 757-842-7296
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Fax |
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Provider Business Mailing Address
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Address Line | 4072 VICTORY BLVD
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City | PORTSMOUTH
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State | VA
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Zip | 23701-2809
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Country | US
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Telephone | 269-601-1780
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Fax | --
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401418648
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901601945
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License Number State | MI
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