# JOHN TILLNER DENTAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730485657
- **Authorized official:** JOHN EMERY TILLNER DDS (DOCTOR/PRESIDENT)
- **Authorized official phone:** (619) 482-6774

## Contact information

- **Practice address:** 752 MEDICAL CENTER CT, STE 205, CHULA VISTA, CA 91911-6658
- **Practice address phone:** (619) 482-6774
- **Practice address fax:** (619) 482-7637
- **Mailing address:** 752 MEDICAL CENTER CT, STE 205, CHULA VISTA, CA 91911-6658
- **Mailing address phone:** (619) 482-6774
- **Mailing address fax:** (619) 482-7637

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 52944 | CA | Yes |

## Other

- **Enumeration date:** 02/10/2011
- **Last updated:** 02/10/2011