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General NPI Number Information
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NPI Number | 1942305719
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Entity Type | Individual
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Provider Name | GREGG RUSSELL DILLAWAY D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 30 COLPITTS RD
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City | WESTON
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State | MA
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Zip | 02493-1534
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Country | US
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Telephone | 781-899-5084
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Fax | 781-642-0609
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Provider Business Mailing Address
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Address Line | PO BOX 181
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City | WESTON
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State | MA
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Zip | 02493-0001
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Country | US
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Telephone | 781-899-5084
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Fax | 781-642-0609
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 17525
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License Number State | MA
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