Individual
DR. CHARLES SAMUEL DILLON III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
513 E YEAGUA, GROESBECK, TX 76642
(254) 729-3818
(254) 729-3198
Mailing address
PO BOX 516, 513 E YEAGUA, GROESBECK, TX 76642
(254) 729-3818
(254) 729-3198
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12958
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
091071301
—
TX
Enumeration date
12/13/2006
Last updated
07/08/2007
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