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NPI Code Detail

MEDICARE: DR. JOHN ROBERT HILDEBRANDT DDS

MEDICARE: DR. JOHN ROBERT HILDEBRANDT DDS
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
11223S0112XOral and Maxillofacial Surgery (Dentist)104783CO

General Provider Information

NPI Number : 1588669600
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOHN ROBERT HILDEBRANDT DDS
Provider Business Mailing Address
First Line : 5745 ERINDALE DR
Second Line : STE 100
City : COLORADO SPRINGS
State : CO
Zip : 80918-8926
Country : US
Telephone Number : 719-473-2650
Fax Number : 719-473-2508
Provider Business Practice Location Address
First Line : 5745 ERINDALE DR
Second Line : STE 100
City : COLORADO SPRINGS
State : CO
Zip : 80918-8926
Country : US
Telephone Number : 719-473-2650
Fax Number : 719-473-2508
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2005
Last Update Date : 04/27/2010

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