Provider Demographics
NPI:1033295209
Name:DILLINGHAM, VICTORIA LILIAN (DR)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:LILIAN
Last Name:DILLINGHAM
Suffix:
Gender:F
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 FIRCREST LN
Mailing Address - Street 2:STE 2
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3960
Mailing Address - Country:US
Mailing Address - Phone:925-828-1420
Mailing Address - Fax:925-828-6147
Practice Address - Street 1:9301 FIRCREST LN
Practice Address - Street 2:STE 2
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3960
Practice Address - Country:US
Practice Address - Phone:925-828-1420
Practice Address - Fax:925-828-6147
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA367621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice