Robert M Dillard, DDS
Individual provider Active NPI Dentist · Okanogan, WA
NPI 1245202829 · NPPES record last updated Nov 3, 2011
Key facts
- NPI
- 1245202829
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DE00010710 (WA)
- Practice address
- 626 Second Ave
Okanogan, WA 98840-1340 - Phone
- (509) 422-6705
- Fax
- (509) 422-6708
- NPI assigned
- Feb 7, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160516001591 | WA | Order and Referring Only - Other (Non-Physician) | 4183913031 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 186 | CO | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE00010710 | WA | Yes |
| General Practice Dentistry | 1223G0001X | 186 | CO |
Addresses
Primary practice location
626 Second Ave
Okanogan, WA 98840-1340
Mailing address
PO Box 1340
Okanogan, WA 98840-1340
Phone (509) 422-7618
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5054812 | Medicaid | WA |
Other providers in Okanogan, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.