Organization
TILLERY DENTAL CLINICS, P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS W. TILLERY (OWNER)
(601) 428-6093
Entity
Organization
Contact information
Practice address
1508 W 10TH ST, LAUREL, MS 39440-2668
(601) 428-6093
(601) 428-6096
Mailing address
1508 W 10TH ST, LAUREL, MS 39440-2668
(601) 428-6093
(601) 428-6096
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
MS133268
MS
Other
Enumeration date
08/16/2006
Last updated
01/03/2008
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