Provider Demographics
NPI:1710455506
Name:DILLINGHAM, MICHAEL MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARTIN
Last Name:DILLINGHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 MISTY SHORE LN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3764
Mailing Address - Country:US
Mailing Address - Phone:512-969-3700
Mailing Address - Fax:
Practice Address - Street 1:2414 CROCKETT DR
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5906
Practice Address - Country:US
Practice Address - Phone:325-646-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX159031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics