Healthcare Provider Details

I. General information

NPI: 1245202829
Provider Name (Legal Business Name): ROBERT M DILLARD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 SECOND AVE
OKANOGAN WA
98840-1340
US

IV. Provider business mailing address

PO BOX 1340
OKANOGAN WA
98840-1340
US

V. Phone/Fax

Practice location:
  • Phone: 509-422-6705
  • Fax: 509-422-6708
Mailing address:
  • Phone: 509-422-7618
  • Fax: 509-422-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00010710
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number186
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: