Provider Demographics
NPI:1033776042
Name:DILLON, JORDAN CHRISTOPHER
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:DILLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8106 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1530
Mailing Address - Country:US
Mailing Address - Phone:304-824-3035
Mailing Address - Fax:304-824-2280
Practice Address - Street 1:8106 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1530
Practice Address - Country:US
Practice Address - Phone:304-824-3035
Practice Address - Fax:304-824-2280
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist