Healthcare Provider Details

I. General information

NPI: 1275907891
Provider Name (Legal Business Name): DILLON & GREENE DENTAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 ATLANTA RD SE SUITE 104
SMYRNA GA
30080-1583
US

IV. Provider business mailing address

2220 ATLANTA RD SE SUITE 104
SMYRNA GA
30080-1583
US

V. Phone/Fax

Practice location:
  • Phone: 770-435-6888
  • Fax: 770-432-7506
Mailing address:
  • Phone: 770-435-6888
  • Fax: 770-432-7506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACY DILLON
Title or Position: DENTIST
Credential: DDS
Phone: 770-435-6888