Individual
CHARLES E TILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
7007 WYOMING BLVD NE, STE A4, ALBUQUERQUE, NM 87109-3987
(505) 821-1433
(505) 821-1442
Mailing address
7007 WYOMING BLVD NE, STE A4, ALBUQUERQUE, NM 87109-3987
(505) 821-1433
(505) 821-1442
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1611
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9179005
—
NM
Enumeration date
10/17/2005
Last updated
11/02/2010
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