Provider Demographics
NPI:1245352566
Name:NEIL DHILLON DMD PC
Entity type:Organization
Organization Name:NEIL DHILLON DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-833-1919
Mailing Address - Street 1:1100 MACDADE BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLYN
Mailing Address - State:PA
Mailing Address - Zip Code:19094-1322
Mailing Address - Country:US
Mailing Address - Phone:610-833-1919
Mailing Address - Fax:610-833-1319
Practice Address - Street 1:1100 MACDADE BLVD
Practice Address - Street 2:
Practice Address - City:WOODLYN
Practice Address - State:PA
Practice Address - Zip Code:19094-1322
Practice Address - Country:US
Practice Address - Phone:610-833-1919
Practice Address - Fax:610-833-1319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0361271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1680249OtherUNITED CONCORDIA PROVIDER