Individual
DR. RODNEY H. HILLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS, PA
Contact information
Practice address
3325 S. HOLMES AVE., IDAHO FALLS, ID 83404
(208) 524-1800
(208) 524-1890
Mailing address
3325 S. HOLMES AVE., IDAHO FALLS, ID 83404
(208) 524-1800
(208) 524-1890
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
113353500
WY
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2019
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002584200
—
ID
05
—
113353500
—
WY
01
—
60301
BLUE CROSS OF ID
ID
01
—
840380
UNITED CONCORDIA
—
Enumeration date
10/07/2008
Last updated
10/07/2008
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