Provider Demographics
NPI:1447765094
Name:ALTERMAN DHILLON AND ASSOCIATES
Entity Type:Organization
Organization Name:ALTERMAN DHILLON AND ASSOCIATES
Other - Org Name:DIXIE DRIVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LORICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-948-6787
Mailing Address - Street 1:PO BOX 603544
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-3544
Mailing Address - Country:US
Mailing Address - Phone:919-948-6787
Mailing Address - Fax:919-590-1711
Practice Address - Street 1:9648 CHAPEL HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7846
Practice Address - Country:US
Practice Address - Phone:919-948-6787
Practice Address - Fax:919-590-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-05
Last Update Date:2021-04-10
Deactivation Date:2020-04-20
Deactivation Code:
Reactivation Date:2020-05-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN