Provider Demographics
NPI:1831371889
Name:DILLON, TANDRA NICOLE (RDH)
Entity type:Individual
Prefix:
First Name:TANDRA
Middle Name:NICOLE
Last Name:DILLON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W ERWIN AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-2646
Mailing Address - Country:US
Mailing Address - Phone:972-542-4331
Mailing Address - Fax:
Practice Address - Street 1:8608 PRESTON RD
Practice Address - Street 2:SUITE 112
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3316
Practice Address - Country:US
Practice Address - Phone:214-619-6329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-02
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13896124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist