Provider Demographics
NPI:1215150222
Name:ROGER W DILLMAN DDS PC
Entity type:Organization
Organization Name:ROGER W DILLMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-723-3800
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454
Mailing Address - Country:US
Mailing Address - Phone:812-723-3800
Mailing Address - Fax:812-723-3800
Practice Address - Street 1:138 S COURT STREET
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454
Practice Address - Country:US
Practice Address - Phone:812-723-3800
Practice Address - Fax:812-723-3800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54000708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty