Provider Demographics
NPI:1578649828
Name:DILLARD, DANIEL ROBERT (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:ROBERT
Last Name:DILLARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:TN
Mailing Address - Zip Code:37185-2120
Mailing Address - Country:US
Mailing Address - Phone:931-296-3882
Mailing Address - Fax:931-296-3856
Practice Address - Street 1:210 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-2120
Practice Address - Country:US
Practice Address - Phone:931-296-3882
Practice Address - Fax:931-296-3856
Is Sole Proprietor?:No
Enumeration Date:2006-10-30
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX157831223G0001X
TNDS9805122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice