Organization
MICHAEL F. TILLERY DDS & ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL FREDRICK TILLERY DDS (OWNER)
(317) 291-8957
Entity
Organization
Contact information
Practice address
3410 N HIGH SCHOOL RD STE B, INDIANAPOLIS, IN 46224-0002
(317) 291-8957
(317) 291-2115
Mailing address
3410 N HIGH SCHOOL RD STE B, INDIANAPOLIS, IN 46224-0002
(317) 291-8957
(317) 291-2115
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7704
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100062710A
—
IN
Enumeration date
05/06/2014
Last updated
05/06/2014
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