Individual
RYAN DAVID HILLAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1820 N.WHITLEY DRIVE, FRUITLAND, ID 83619
(208) 452-4808
(208) 452-6617
Mailing address
1820 N.WHITLEY DRIVE, FRUITLAND, ID 83619
(208) 452-4808
(208) 452-6617
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3949
ID
Other
Enumeration date
10/26/2006
Last updated
11/20/2009
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