# TILLERY GROUP PA

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

## Provider details

- **NPI number:** 1902020118
- **Authorized official:** DR. DON E TILLERY JR. DMD (OWNER AND SURGEON)
- **Authorized official phone:** (407) 628-5400

## Contact information

- **Practice address:** 800 W MORSE BLVD, SUITE 2, WINTER PARK, FL 32789-3797
- **Practice address phone:** (407) 628-5400
- **Practice address fax:** (407) 628-5389
- **Mailing address:** 800 W MORSE BLVD, SUITE 2, WINTER PARK, FL 32789-3797
- **Mailing address phone:** (407) 628-5400
- **Mailing address fax:** (407) 628-5389

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 10178 | FL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 16103 | FL | — |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 09/23/2014