MEDICARE: DR. MICHAEL RICHARD HILLEARY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3640	WV

General Provider Information

NPI Number	:	1194807214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RICHARD HILLEARY D.D.S.

Provider Business Mailing Address
First Line	:	44 OLD HOUSE LN
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26505-1718
Country	:	US
Telephone Number	:	304-599-3620
Fax Number	:

Provider Business Practice Location Address
First Line	:	157 HOLLAND AVE
Second Line	:
City	:	WESTOVER
State	:	WV
Zip	:	26501-4315
Country	:	US
Telephone Number	:	304-296-1721
Fax Number	:	304-296-1115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	07/08/2007

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