Provider Demographics
NPI:1942756184
Name:DILL, ALISA (DDS)
Entity Type:Individual
Prefix:
First Name:ALISA
Middle Name:
Last Name:DILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 RICHMOND AVE APT 476
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-3613
Mailing Address - Country:US
Mailing Address - Phone:832-858-9764
Mailing Address - Fax:
Practice Address - Street 1:1701 FAIRWAY DR. #20
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511
Practice Address - Country:US
Practice Address - Phone:281-331-0020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX321571223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice