MEDICARE: DR. GROVER CLEVELAND HILL JR. 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	1223G0001X	General Practice Dentistry	4647	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4647	OTHER	VA	STATE DENTAL LICENSE

General Provider Information

NPI Number	:	1457492506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GROVER CLEVELAND HILL JR. D.D.S.

Provider Business Mailing Address
First Line	:	195 S ROSEMONT RD
Second Line	:	SUITE 116
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4353
Country	:	US
Telephone Number	:	757-498-6988
Fax Number	:	757-498-8825

Provider Business Practice Location Address
First Line	:	195 S ROSEMONT RD
Second Line	:	SUITE 116
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4353
Country	:	US
Telephone Number	:	757-498-6988
Fax Number	:	757-498-8825

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

Provider Enumeration Date	:	02/10/2007
Last Update Date	:	07/08/2007

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