Provider Demographics
NPI:1275907891
Name:DILLON & GREENE DENTAL SERVICES LLC
Entity Type:Organization
Organization Name:DILLON & GREENE DENTAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-435-6888
Mailing Address - Street 1:2220 ATLANTA RD SE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-1583
Mailing Address - Country:US
Mailing Address - Phone:770-435-6888
Mailing Address - Fax:770-432-7506
Practice Address - Street 1:2220 ATLANTA RD SE
Practice Address - Street 2:SUITE 104
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-1583
Practice Address - Country:US
Practice Address - Phone:770-435-6888
Practice Address - Fax:770-432-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty