Individual
JERRY WAYNE DILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S., M.S., PH.D.
Contact information
Practice address
2000 RIVER OAKS DR, CALUMET CITY, IL 60409-5074
(708) 862-1800
Mailing address
PO BOX 1355, CALUMET CITY, IL 60409-1355
(708) 862-1800
(708) 862-5098
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019022622
IL
1223G0001X
General Practice Dentistry
2539-90
MS
1223P0300X
Periodontics
019022622
IL
Other
Enumeration date
06/05/2008
Last updated
06/05/2008
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