Provider Demographics
NPI:1538337480
Name:DILLON DERMATOLOGY LLC
Entity type:Organization
Organization Name:DILLON DERMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:I
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-373-6046
Mailing Address - Street 1:1037 CONNEAUT AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-5301
Mailing Address - Country:US
Mailing Address - Phone:419-373-6046
Mailing Address - Fax:419-352-9048
Practice Address - Street 1:1037 CONNEAUT AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-5301
Practice Address - Country:US
Practice Address - Phone:419-373-6046
Practice Address - Fax:419-352-9048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35064057D207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1538337480OtherMEDICAL MUTUAL OF OHIO
OH1538337480OtherRAILROAD MEDICARE
OH1538337480OtherHEALTHREACH
OH1538337480OtherFRONTPATH HEALTH COALITION
OH1538337480OtherMEDICAL MUTUAL OF OHIO