MEDICARE: JOHN BRUCE HILLIN 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
1	1223G0001X	General Practice Dentistry	12453	TX

General Provider Information

NPI Number	:	1861494973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BRUCE HILLIN DDS

Provider Business Mailing Address
First Line	:	109 RICHARDSON DR
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75654-3989
Country	:	US
Telephone Number	:	903-657-2266
Fax Number	:	903-657-1090

Provider Business Practice Location Address
First Line	:	109 RICHARDSON DR
Second Line	:
City	:	HENDERSON
State	:	TX
Zip	:	75654-3989
Country	:	US
Telephone Number	:	903-657-2266
Fax Number	:	903-657-1090

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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