Charles Samuel Dillon III, DDS
Individual provider Active NPI General Practice Dentistry · Groesbeck, TX
NPI 1831250752 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1831250752
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 12958 (TX)
- Practice address
- 513 E Yeagua
Groesbeck, TX 76642 - Phone
- (254) 729-3818
- Fax
- (254) 729-3198
- NPI assigned
- Dec 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tru Dental | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 12958 | TX | Yes |
Addresses
Primary practice location
513 E Yeagua
Groesbeck, TX 76642
Mailing address
PO Box 516
513 E Yeagua
Groesbeck, TX 76642
Phone (254) 729-3818
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 091071301 | Medicaid | TX |
Other providers in Groesbeck, TX
- Christopher Ty Chiglo
- Chris R. Rand O.D.,P.a.
- Connie'S Assisted Living Home of Ben Hur
- Coryell County Memorial Hospital Authority
- County Hematology-Oncology Clinics
- Dale E. Dyer
- Donald Lynn Glass
- Eduardo Abraham Gonzalez Fernandez
- Groesbeck City Drug
- Groesbeck Dentist PLLC
All providers in Groesbeck, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.