Provider Demographics
NPI:1255679387
Name:DILLON, JESSICA RUTH (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:RUTH
Last Name:DILLON
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 1:1933 CASSIA RD
Mailing Address - Street 2:APT. 203
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-4167
Mailing Address - Country:US
Mailing Address - Phone:734-834-3128
Mailing Address - Fax:
Practice Address - Street 1:1ST DENTAL BATTALION
Practice Address - Street 2:BOX 555221
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:734-834-3128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice