Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 038405 | NY |
NPI | 1003938689 |
---|---|
Provider Name | Dr. Scott Dillingham |
First Address | Cazenovia, NY 13035-9304 |
Second Address | Fayetteville, NY 13066-9692 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 03/04/2009 |