MEDICARE: HITE FAMILY DENTISTRY LLC

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	332BC3200X	Customized Equipment (DME)
2	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1376316158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HITE FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	1427 LEWIS RD
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-4148
Country	:	US
Telephone Number	:	618-656-9123
Fax Number	:	618-656-9245

Provider Business Practice Location Address
First Line	:	1427 LEWIS RD
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-4148
Country	:	US
Telephone Number	:	618-656-9123
Fax Number	:	618-656-9245

Authorized Official
Title or Position	:	OWNER
Name	:	BENJAMIN HITE
Credential	:	DMD
Telephone Number	:	618-656-9123

Provider Enumeration Date	:	11/02/2023
Last Update Date	:	05/14/2024

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Directions to “HITE FAMILY DENTISTRY LLC ” Practice Location

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