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NPI Code Detail

MEDICARE: DR. GREGG RUSSELL DILLAWAY D.M.D.

MEDICARE: DR. GREGG RUSSELL DILLAWAY D.M.D.
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
11223G0001XGeneral Practice Dentistry17525MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1X06467DIOTHERMABCBS PROVIDER
2807OTHERMADELTA DENTAL PROVIDER
317525OTHERMAMA STATE LICENSE

General Provider Information

NPI Number : 1942305719
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGG RUSSELL DILLAWAY D.M.D.
Provider Business Mailing Address
First Line : PO BOX 181
Second Line :
City : WESTON
State : MA
Zip : 02493-0001
Country : US
Telephone Number : 781-899-5084
Fax Number : 781-642-0609
Provider Business Practice Location Address
First Line : 30 COLPITTS RD
Second Line :
City : WESTON
State : MA
Zip : 02493-1534
Country : US
Telephone Number : 781-899-5084
Fax Number : 781-642-0609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2006
Last Update Date : 03/07/2023

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