Individual
DR. JORDAN RODNEY HILLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
758 E 65TH S, IDAHO FALLS, ID 83404-7696
(208) 360-9119
Mailing address
758 E 65TH S, IDAHO FALLS, ID 83404-7696
(208) 360-9119
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4648
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/25/2013
Last updated
03/01/2018
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