Provider Demographics
NPI:1710117734
Name:BILL C.W. DILL III DDS
Entity Type:Organization
Organization Name:BILL C.W. DILL III DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:CW
Authorized Official - Last Name:DILL
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-443-4440
Mailing Address - Street 1:2646 E JOYCE BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-4435
Mailing Address - Country:US
Mailing Address - Phone:479-443-4440
Mailing Address - Fax:479-443-4450
Practice Address - Street 1:2646 E JOYCE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-4435
Practice Address - Country:US
Practice Address - Phone:479-443-4440
Practice Address - Fax:479-443-4450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR58122OtherBLUE CROSS BLUE SHIELD
AR160839608Medicaid