Provider Demographics
NPI:1245250208
Name:DILLON, TRACY EUGENE (DDS)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:EUGENE
Last Name:DILLON
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 1:550 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1780
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-2247
Mailing Address - Country:US
Mailing Address - Phone:404-589-1160
Mailing Address - Fax:404-589-1161
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1780
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2247
Practice Address - Country:US
Practice Address - Phone:404-589-1160
Practice Address - Fax:404-589-1161
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122621223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAV00641Medicare UPIN
GA19NCCCWMedicare ID - Type Unspecified