Provider Demographics
NPI:1841349602
Name:DILLON, PETER K (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:K
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 1:45 RYANT BLVD
Mailing Address - Street 2:WEST SHORE PLAZA
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-4075
Mailing Address - Country:US
Mailing Address - Phone:863-382-4464
Mailing Address - Fax:863-471-0436
Practice Address - Street 1:45 RYANT BLVD
Practice Address - Street 2:WEST SHORE PLAZA
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-4075
Practice Address - Country:US
Practice Address - Phone:863-382-4464
Practice Address - Fax:863-471-0436
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL102731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice