Provider Demographics
NPI:1689953960
Name:DILLON, JENNIFER ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANNE
Last Name:DILLON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4103
Mailing Address - Country:US
Mailing Address - Phone:404-328-7171
Mailing Address - Fax:470-355-4795
Practice Address - Street 1:144 S COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4103
Practice Address - Country:US
Practice Address - Phone:404-328-7171
Practice Address - Fax:470-355-4795
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-04
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY91011223G0001X
GADN014385122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice