Provider Demographics
NPI:1598856684
Name:MICHAEL M. DILLINGHAM, D.D.S.,P.C.
Entity Type:Organization
Organization Name:MICHAEL M. DILLINGHAM, D.D.S.,P.C.
Other - Org Name:AUSTIN ORTHODONTIC SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEFFINEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-836-7924
Mailing Address - Street 1:2121 W PARMER LN
Mailing Address - Street 2:STE. 111
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-4300
Mailing Address - Country:US
Mailing Address - Phone:512-836-7924
Mailing Address - Fax:512-836-7977
Practice Address - Street 1:2121 W PARMER LN
Practice Address - Street 2:STE. 111
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4300
Practice Address - Country:US
Practice Address - Phone:512-836-7924
Practice Address - Fax:512-836-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty