Healthcare Provider Details

I. General information

NPI: 1598869711
Provider Name (Legal Business Name): RICHARD TERRENCE DILLON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TERRENCE DILLON MD

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WYOMING ST
DAYTON OH
45409-2722
US

IV. Provider business mailing address

5450 FAR HILLS AVE SUITE 124
KETTERING OH
45429-2386
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2907
  • Fax: 937-208-5415
Mailing address:
  • Phone: 937-435-2920
  • Fax: 937-435-2190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.039864
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number35039864D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: