Provider Demographics
NPI:1447485131
Name:HILL, JEREMY WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:WAYNE
Last Name:HILL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-2408
Mailing Address - Country:US
Mailing Address - Phone:307-527-4455
Mailing Address - Fax:307-587-4561
Practice Address - Street 1:1110 BECK AVE
Practice Address - Street 2:
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3624
Practice Address - Country:US
Practice Address - Phone:307-527-4455
Practice Address - Fax:307-587-4561
Is Sole Proprietor?:No
Enumeration Date:2009-05-25
Last Update Date:2009-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY11571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice