Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 1410 | NH |
NPI | 1548368681 |
---|---|
Provider Name | Thomas A Hillebrand |
First Address | Claremont, NH 03743-5615 |
Second Address | Claremont, NH 03743-5615 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001893 | (05) | VT |
89191893 | (05) | NH |