Healthcare Provider Details

I. General information

NPI: 1609865286
Provider Name (Legal Business Name): MICHAEL J DILLON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 MENDOTA RD
INVER GROVE HEIGHTS MN
55077-1255
US

IV. Provider business mailing address

1320 MENDOTA RD
INVER GROVE HEIGHTS MN
55077-1255
US

V. Phone/Fax

Practice location:
  • Phone: 651-451-1884
  • Fax: 651-306-9709
Mailing address:
  • Phone: 651-451-1884
  • Fax: 651-306-9709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9568
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: