Michael Shane Dilllard, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN013709 Issued in GA

Practice address

2400 Wisteria Dr Ste D
Snellville, GA 30078-2689

Phone

(770) 979-7794

NPI assigned

May 22, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300924800000",
    "number": "1962669200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9492 GREENS MILL CT",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300525265",
            "telephone_number": "770-264-7951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 WISTERIA DR STE D",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782689",
            "telephone_number": "770-979-7794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DILLLARD",
        "first_name": "MICHAEL",
        "middle_name": "SHANE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-22",
        "last_updated": "2011-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN013709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanvi Mamud Dhanani, PA-C
• Diabetes and Endocrinology of Snellville, LLC
• Matthew Dial, RBT
• Sebastian Diaz, DC
• Angel A Diedrich, RN
• Hannah Marie Dillon, PT, DPT
• Divine Touch Services, LLC
• Ashley N Dixon
• Jamila Dixon, CNA
• Mechelle M Dixon

• General Practice Dentistry in Snellville, GA
• Providers in Snellville, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.