Provider Demographics
NPI:1437459609
Name:DHYLLON, AMEN (DDS)
Entity Type:Individual
Prefix:
First Name:AMEN
Middle Name:
Last Name:DHYLLON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:401 COMMERCE DR
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-2714
Mailing Address - Country:US
Mailing Address - Phone:215-550-7186
Mailing Address - Fax:215-646-6369
Practice Address - Street 1:301 E CITY LINE AVE
Practice Address - Street 2:SUITE G3
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1708
Practice Address - Country:US
Practice Address - Phone:610-660-9510
Practice Address - Fax:610-660-9512
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS038245122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist