MEDICARE: KARA LYNN DILLON RDH EA

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	124Q00000X	Dental Hygienist	DH 1351 EA	ID

General Provider Information

NPI Number	:	1225187172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA LYNN DILLON RDH EA

Provider Business Mailing Address
First Line	:	PO BOX 786
Second Line	:
City	:	COUNCIL
State	:	ID
Zip	:	83612-0786
Country	:	US
Telephone Number	:	208-253-6447
Fax Number	:	208-253-6849

Provider Business Practice Location Address
First Line	:	205 N BERKLEY
Second Line	:
City	:	COUNCIL
State	:	ID
Zip	:	83612
Country	:	US
Telephone Number	:	208-253-6447
Fax Number	:	208-253-6849

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	07/08/2007

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