MEDICARE: DR. LEWIS JOHN DILLARD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN123372	GA
2	122300000X	Dentist	DS042192	PA
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	DN123372	GA
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DS042192	PA

General Provider Information

NPI Number	:	1124688841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS JOHN DILLARD DDS

Provider Business Mailing Address
First Line	:	5283 BELLS FERRY RD # RR
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-2500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5283 BELLS FERRY RD
Second Line	:
City	:	ACWORTH
State	:	GA
Zip	:	30102-2500
Country	:	US
Telephone Number	:	770-516-7153
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	11/21/2025

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