1811945348 NPI number — BYRON THEODORE HILDAHL DDS

Table of content: BYRON THEODORE HILDAHL DDS (NPI 1811945348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811945348 NPI number — BYRON THEODORE HILDAHL DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILDAHL
Provider First Name:
BYRON
Provider Middle Name:
THEODORE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811945348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 W FRANCIS AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99205-6401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-327-3368
Provider Business Mailing Address Fax Number:
509-325-2712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 W FRANCIS AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-6401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-3368
Provider Business Practice Location Address Fax Number:
509-325-2712
Provider Enumeration Date:
05/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  3818 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3517 . This is a "DELTA PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 136630 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 804444 . This is a "UNITED CON. PROVIDER NUM." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5012059 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".