Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0700X | Prosthodontist | 20089 | TX |
N | 1223X0400X | Orthodontists | 20089 | TX |
NPI | 1255540688 |
---|---|
Provider Name | Dr. Brody Jamison Hildebrand |
First Address | Dallas, TX 75225-5523 |
Second Address | Dallas, TX 75225-5523 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |