Individual
DONALD W TILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
657 LONE OAK RD STE 5, PADUCAH, KY 42003-4547
(270) 442-5071
Mailing address
3725 BROOKLINE DR, PADUCAH, KY 42001-5221
(270) 442-5071
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5186
KY
Other
Enumeration date
05/30/2007
Last updated
07/08/2007
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