Healthcare Provider Details

I. General information

NPI: 1467035899
Provider Name (Legal Business Name): DILLON WILLIAM DELANEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57121 FOOTHILL RD
SAINT IGNATIUS MT
59865-9586
US

IV. Provider business mailing address

57121 FOOTHILL RD
SAINT IGNATIUS MT
59865-9586
US

V. Phone/Fax

Practice location:
  • Phone: 406-465-9805
  • Fax:
Mailing address:
  • Phone: 406-465-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21438
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: