Organization
RODNEY H HILLAM DDS MS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RODNEY H HILLAM DDS MS PA (OWNER PRESIDENT)
(208) 524-1800
Entity
Organization
Contact information
Practice address
3325 S HOLMES AVE, IDAHO FALLS, ID 83404-7981
(206) 524-1800
(208) 524-1890
Mailing address
3325 S HOLMES AVE, IDAHO FALLS, ID 83404-7981
(206) 524-1800
(208) 524-1890
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
2019
ID
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
918
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
60301
BLUECROSS
—
01
—
840380
UNITED CONCORDIA
—
Enumeration date
02/28/2007
Last updated
08/22/2020
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