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General NPI Number Information
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NPI Number | 1649657255
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Entity Type | Organization
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Legal Business Name | MELVIN AND JAZMINE DILLARD DDS, PC
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 1964 DEMPSTER ST
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City | EVANSTON
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State | IL
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Zip | 60202-1016
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Country | US
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Telephone | 312-600-8119
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Fax |
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Provider Business Mailing Address
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Address Line | 1964 DEMPSTER ST
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City | EVANSTON
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State | IL
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Zip | 60202-1016
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. MELVIN DILLARD
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Credential | DDS
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Telephone | 847-563-4484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019029481
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 021002650
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License Number State | IL
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