Provider Demographics
NPI:1750874178
Name:HILLS, RYAN MAX (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:MAX
Last Name:HILLS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11670 E TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:MI
Mailing Address - Zip Code:48877-9512
Mailing Address - Country:US
Mailing Address - Phone:989-304-0120
Mailing Address - Fax:
Practice Address - Street 1:1317 PINE AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1242
Practice Address - Country:US
Practice Address - Phone:989-463-4711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010226631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice