Provider Demographics
NPI:1528274180
Name:DILLMAN, RAY E (DDS PC)
Entity type:Individual
Prefix:
First Name:RAY
Middle Name:E
Last Name:DILLMAN
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11946 HIDDEN CANYON LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-7196
Mailing Address - Country:US
Mailing Address - Phone:801-553-9434
Mailing Address - Fax:
Practice Address - Street 1:2180 FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-3148
Practice Address - Country:US
Practice Address - Phone:801-944-4141
Practice Address - Fax:801-944-6377
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139552-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice