Healthcare Provider Details

I. General information

NPI: 1356235428
Provider Name (Legal Business Name): DILLON ALLEN ESCUDERO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 E 17TH AVE
HUTCHINSON KS
67501-1114
US

IV. Provider business mailing address

9634 W CEDAR LN
MAIZE KS
67101-8000
US

V. Phone/Fax

Practice location:
  • Phone: 620-888-2998
  • Fax:
Mailing address:
  • Phone: 253-230-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62318
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: