Individual
DR. MARTIN GEORGE TILLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S., P.C.
Contact information
Practice address
516 W 39TH ST, SUITE D TOWER PLAZA, KEARNEY, NE 68845-2881
(308) 865-2577
(308) 234-9526
Mailing address
516 W 39TH ST, SUITE D TOWER PLAZA, KEARNEY, NE 68845-2881
(308) 865-2577
(308) 234-9526
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
4560
NE
208600000X
Surgery Physician
Primary
16420
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3663
BLUE CROSS BLUE SHIELD
NE
05
—
47067456101
—
NE
01
—
5400
BLUE CROSS BLUE SHIELD
NE
Enumeration date
11/28/2006
Last updated
09/11/2025
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