Basic Information
| Provider Information | |||||||||
| NPI: | 1740594571 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHILLON | ||||||||
| FirstName: | INDERRAJ | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1740 W 17TH AVE # 105 | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974023619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4582103543 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1740 W 17TH AVE | ||||||||
| Address2: | |||||||||
| City: | EUGENE | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974023619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4582103543 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2010 | ||||||||
| LastUpdateDate: | 03/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | D008567 | AZ | N | Dental Providers | Dentist | 1223S0112X | G3-0000378 | DE | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 1223S0112X | D11020 | OR | N | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 122300000X | D11020 | OR | Y | Dental Providers | Dentist |
No ID Information.