Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 007896 | CT |
N | 1223D0004X | Dentist Anesthesiologist | 041953 | NY |
NPI | 1669775508 |
---|---|
Provider Name | Dr. Scott Maurice Dillard |
First Address | Manchester, CT 06040-3924 |
Second Address | Manchester, CT 06040-3924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2010 |
Last Update Date | 09/05/2014 |