Provider Demographics
NPI:1467035899
Name:DELANEY, DILLON WILLIAM
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:WILLIAM
Last Name:DELANEY
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 1:57121 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865-9586
Mailing Address - Country:US
Mailing Address - Phone:406-465-9805
Mailing Address - Fax:
Practice Address - Street 1:57121 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:SAINT IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865-9586
Practice Address - Country:US
Practice Address - Phone:406-465-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT214381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program