Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 312600 | MS |
NPI | 1134238322 |
---|---|
Provider Name | Mr. Lance D Dillon |
First Address | Madison, MS 39110 |
Second Address | Madison, MS 39110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |