Provider Demographics
NPI:1215711924
Name:DILLARD, MARKEN JEAN
Entity type:Individual
Prefix:
First Name:MARKEN
Middle Name:JEAN
Last Name:DILLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4874 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-6006
Mailing Address - Country:US
Mailing Address - Phone:937-405-3336
Mailing Address - Fax:
Practice Address - Street 1:4874 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45424-6006
Practice Address - Country:US
Practice Address - Phone:937-405-3336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)