MEDICARE: DR. EMILY YOUNG DILLMAN 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	122300000X	Dentist	12013619A	IN

General Provider Information

NPI Number	:	1518532043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMILY YOUNG DILLMAN DDS

Provider Business Mailing Address
First Line	:	7110 HIGH JACKSON RD
Second Line	:
City	:	CHARLESTOWN
State	:	IN
Zip	:	47111-8924
Country	:	US
Telephone Number	:	502-689-2479
Fax Number	:

Provider Business Practice Location Address
First Line	:	753 W MAIN ST
Second Line	:
City	:	MADISON
State	:	IN
Zip	:	47250-3150
Country	:	US
Telephone Number	:	812-265-5962
Fax Number	:

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

Provider Enumeration Date	:	05/26/2021
Last Update Date	:	04/19/2022

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