Provider Demographics
NPI:1124184569
Name:DILL, GREGORY JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JAY
Last Name:DILL
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:PO BOX 818
Mailing Address - Street 2:102 E CUMBERLAND
Mailing Address - City:GREENUP
Mailing Address - State:IL
Mailing Address - Zip Code:62428-0818
Mailing Address - Country:US
Mailing Address - Phone:217-923-5292
Mailing Address - Fax:217-923-3682
Practice Address - Street 1:102 E CUMBERLAND
Practice Address - Street 2:
Practice Address - City:GREENUP
Practice Address - State:IL
Practice Address - Zip Code:62428-0818
Practice Address - Country:US
Practice Address - Phone:217-923-5292
Practice Address - Fax:217-923-3682
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist