Provider Demographics
NPI:1235328279
Name:DILLARD, KRISTI AMMONS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:AMMONS
Last Name:DILLARD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3070 HIGHWAY 17 NORTH
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-8958
Mailing Address - Country:US
Mailing Address - Phone:843-849-9990
Mailing Address - Fax:843-849-9656
Practice Address - Street 1:3070 HIGHWAY 17 NORTH
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:843-849-9990
Practice Address - Fax:843-849-9656
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice