Individual provider Active NPI

O Jerry Hill Jr., DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Statesville, NC
National Provider Identifier
1720004518
Registry record updated Aug 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
NC4205 Issued in NC
Practice address
925 Thomas St
Statesville, NC 28677-3484
Phone
(704) 873-0263
Fax
(704) 873-1813
NPI assigned
Jul 14, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 30, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X NC4205 NC Primary

Addresses

Primary practice location

925 Thomas St
Statesville, NC 28677-3484

Mailing address

925 Thomas St
Statesville, NC 28677-3484
Phone (704) 873-0263

Other identifiers 1

IdentifierTypeStateIssuer
89-93902MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NC4205NCMDOral and Maxillofacial Surgery (Dentist)

NPI Registry JSON

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

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788048000000",
    "number": "1720004518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 THOMAS ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773484",
            "telephone_number": "704-873-0263",
            "fax_number": "704-873-1813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 THOMAS ST",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773484",
            "telephone_number": "704-873-0263",
            "fax_number": "704-873-1813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HILL",
        "first_name": "O",
        "middle_name": "JERRY",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-14",
        "last_updated": "2026-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NC",
            "license": "NC4205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89-93902",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.