Provider Demographics
NPI:1982232062
Name:DILLON & DILLON DENTISTRY II, INC.
Entity Type:Organization
Organization Name:DILLON & DILLON DENTISTRY II, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-824-3035
Mailing Address - Street 1:8106 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1530
Mailing Address - Country:US
Mailing Address - Phone:304-824-3035
Mailing Address - Fax:304-824-2280
Practice Address - Street 1:8106 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1530
Practice Address - Country:US
Practice Address - Phone:304-824-3035
Practice Address - Fax:304-824-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1033776042Medicaid