Provider Demographics
NPI:1831863588
Name:DILLON, TRENT IRIL
Entity type:Individual
Prefix:
First Name:TRENT
Middle Name:IRIL
Last Name:DILLON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 VINE AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-3811
Mailing Address - Country:US
Mailing Address - Phone:862-338-2998
Mailing Address - Fax:
Practice Address - Street 1:40 VINE AVE
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07111-3811
Practice Address - Country:US
Practice Address - Phone:862-338-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD43747506906862172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver