Provider Demographics
NPI:1245202829
Name:DILLARD, ROBERT M (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:DILLARD
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 1340
Mailing Address - Street 2:
Mailing Address - City:OKANOGAN
Mailing Address - State:WA
Mailing Address - Zip Code:98840-1340
Mailing Address - Country:US
Mailing Address - Phone:509-422-7618
Mailing Address - Fax:509-422-7680
Practice Address - Street 1:626 SECOND AVE
Practice Address - Street 2:
Practice Address - City:OKANOGAN
Practice Address - State:WA
Practice Address - Zip Code:98840-1340
Practice Address - Country:US
Practice Address - Phone:509-422-6705
Practice Address - Fax:509-422-6708
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010710122300000X
CO1861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5054812Medicaid