Ryan David Hillam, DDS
Individual provider Active NPI Dentist · Fruitland, ID
NPI 1992880132 · NPPES record last updated Nov 20, 2009
Key facts
- NPI
- 1992880132
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D3949 (ID)
- Practice address
- 1820 N.Whitley Drive
Fruitland, ID 83619 - Phone
- (208) 452-4808
- Fax
- (208) 452-6617
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3949 | ID | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D3949 | ID | Yes |
Addresses
Primary practice location
1820 N.Whitley Drive
Fruitland, ID 83619
Mailing address
1820 N.Whitley Drive
Fruitland, ID 83619
Phone (208) 452-4808
Other providers in Fruitland, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.