# DILLE DENTAL, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DILLE DENTAL, PLLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1952749335
- **Legal business name:** DILLE DENTAL, PLLC
- **Authorized official:** BRYAN J DILLE DDS (OWNER/DENTIST)
- **Authorized official phone:** (208) 549-1732

## Contact information

- **Practice address:** 90 S SUPERIOR STREET, CAMBRIDGE, ID 83610
- **Practice address phone:** (208) 257-4522
- **Practice address fax:** (208) 257-4523
- **Mailing address:** PO BOX 369, CAMBRIDGE, ID 83610-0369
- **Mailing address phone:** (208) 257-4522
- **Mailing address fax:** (208) 257-4523

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D4240 | ID | Yes |

## Other

- **Enumeration date:** 06/07/2013
- **Last updated:** 06/07/2013