Provider Demographics
NPI:1275676389
Name:DILLON, BETTY (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BETTY
Other - Middle Name:
Other - Last Name:DILLON-MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:900 N HAIRSTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-2857
Mailing Address - Country:US
Mailing Address - Phone:404-294-8500
Mailing Address - Fax:404-294-4844
Practice Address - Street 1:900 N HAIRSTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-2857
Practice Address - Country:US
Practice Address - Phone:404-294-8500
Practice Address - Fax:404-294-4844
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0011434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist