Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22DI00961800 | NJ |
NPI | 1255435772 |
---|---|
Provider Name | Dr. Kenneth L Hilsen |
First Address | Upper Saddle River, NJ 07458-2910 |
Second Address | Teaneck, NJ 07666-4249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 06/12/2013 |