Individual
COLTON R TILLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8401 EXECUTIVE PARK DR #120, CHARLOTTE, NC 28262
(704) 548-8563
Mailing address
536 W TREMONT AVE UNIT 350, CHARLOTTE, NC 28203
(681) 888-1295
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13775
NC
Other
Enumeration date
06/26/2024
Last updated
06/26/2024
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