Provider Demographics
NPI:1225187172
Name:DILLON, KARA LYNN (RDH EA)
Entity type:Individual
Prefix:
First Name:KARA
Middle Name:LYNN
Last Name:DILLON
Suffix:
Gender:F
Credentials:RDH EA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:COUNCIL
Mailing Address - State:ID
Mailing Address - Zip Code:83612-0786
Mailing Address - Country:US
Mailing Address - Phone:208-253-6447
Mailing Address - Fax:208-253-6849
Practice Address - Street 1:205 N BERKLEY
Practice Address - Street 2:
Practice Address - City:COUNCIL
Practice Address - State:ID
Practice Address - Zip Code:83612
Practice Address - Country:US
Practice Address - Phone:208-253-6447
Practice Address - Fax:208-253-6849
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDDH 1351 EA124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist