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General NPI Number Information
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NPI Number | 1275907891
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Entity Type | Organization
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Legal Business Name | DILLON & GREENE DENTAL SERVICES LLC
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Dates
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Enumeration Date | 11/19/2015
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 2220 ATLANTA RD SE SUITE 104
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City | SMYRNA
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State | GA
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Zip | 30080-1583
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Country | US
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Telephone | 770-435-6888
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Fax | 770-432-7506
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Provider Business Mailing Address
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Address Line | 2220 ATLANTA RD SE SUITE 104
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City | SMYRNA
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State | GA
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Zip | 30080-1583
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Country | US
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Telephone | 770-435-6888
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Fax | 770-432-7506
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TRACY DILLON
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Credential | DDS
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Telephone | 770-435-6888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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