Individual provider Active NPI

David J Hill, D.D.S.

  • General Practice Dentistry
  • Jackson, MI
National Provider Identifier
1700958477
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D14862 Issued in MI
Practice address
123 N West Ave
Suite C
Jackson, MI 49201-1926
Phone
(517) 784-0038
Fax
(517) 783-9858
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D14862 MI Primary

Addresses

Primary practice location

123 N West Ave
Suite C
Jackson, MI 49201-1926

Mailing address

17410 Fairway Dr
Detroit, MI 48221-2782
Phone (313) 863-7805

Other identifiers 1

IdentifierTypeStateIssuer
1869334MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200513000599 MI Practitioner - Dentist 4789989237

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D14862MIMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1700958477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17410 FAIRWAY DR",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482212782",
            "telephone_number": "313-863-7805",
            "fax_number": "517-783-9858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 N WEST AVE",
            "address_2": "SUITE C",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011926",
            "telephone_number": "517-784-0038",
            "fax_number": "517-783-9858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILL",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "D14862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1869334",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.