Tillery Dental Clinics, P.a. | |
1508 W 10th St Laurel MS 39440-2668 | |
(601) 428-6093 | |
(601) 428-6096 |
Full Name | Tillery Dental Clinics, P.a. |
---|---|
Speciality | Dentist - General Practice |
Location | 1508 W 10th St, Laurel, Mississippi |
Authorized Official Name and Position | Douglas W. Tillery (OWNER) |
Authorized Official Contact | 6014286093 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Tillery Dental Clinics, P.a. 1508 W 10th St Laurel MS 39440-2668 Ph: (601) 428-6093 | Tillery Dental Clinics, P.a. 1508 W 10th St Laurel MS 39440-2668 Ph: (601) 428-6093 |
NPI Number | 1376656041 |
---|---|
Provider Enumeration Date | 08/16/2006 |
Last Update Date | 01/03/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1376656041 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | MS133268 (Mississippi) | Primary |
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