MEDICARE: DR. RUSSELL R HILLIARD 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	12735	TX

General Provider Information

NPI Number	:	1659364198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RUSSELL R HILLIARD D.D.S.

Provider Business Mailing Address
First Line	:	4910 WILLOWBEND BLVD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77035-3222
Country	:	US
Telephone Number	:	713-729-1813
Fax Number	:	713-729-6080

Provider Business Practice Location Address
First Line	:	4910 WILLOWBEND BLVD
Second Line	:	SUITE C
City	:	HOUSTON
State	:	TX
Zip	:	77035-3222
Country	:	US
Telephone Number	:	713-729-1813
Fax Number	:	713-729-6080

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	07/08/2007

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