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Individual

EDGAR TILLEY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
4 SUNSET WAY STE C, HENDERSON, NV 89014-2016
(702) 968-1682
Mailing address
5918 CRUMBLING RIDGE ST, HENDERSON, NV 89011-1611
(385) 207-5175

Taxonomy

Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DE61632800
WA

Other

Enumeration date
01/07/2025
Last updated
01/07/2025
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