Provider Demographics
NPI:1023348489
Name:HILTON, MARK (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HILTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:F
Other - Last Name:HILTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS,PC
Mailing Address - Street 1:4585 WASHINGTON ST
Mailing Address - Street 2:C-3
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5858
Mailing Address - Country:US
Mailing Address - Phone:314-831-4660
Mailing Address - Fax:
Practice Address - Street 1:4585 WASHINGTON ST
Practice Address - Street 2:C-3
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5858
Practice Address - Country:US
Practice Address - Phone:314-831-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MODE014146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist