MEDICARE: RAY E DILLMAN D.D.S. P.C.

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	1223G0001X	General Practice Dentistry	139552-9922	UT

General Provider Information

NPI Number	:	1528274180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAY E DILLMAN D.D.S. P.C.

Provider Business Mailing Address
First Line	:	11946 HIDDEN CANYON LN
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-7196
Country	:	US
Telephone Number	:	801-553-9434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 FORT UNION BLVD
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-3148
Country	:	US
Telephone Number	:	801-944-4141
Fax Number	:	801-944-6377

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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