Organization
MARTIN G. TILLEY D.D.S., M.D., P.C.
Active
Organization
MARTIN G. TILLEY D.D.S., M.D., P.C.
Active
Parent organization
MARTIN G. TILLEY D.D.S., M.D., P.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARTIN G. TILLEY D.D.S., M.D., P.C.
Authorized official
DR. MARTIN GEORGE TILLEY M.D., D.D.S. P.C. (OWNER)
(308) 865-2577
Entity
Organization
Contact information
Practice address
516 W 39TH ST, SUITE D TOWER PLAZA, KEARNEY, NE 68845-2881
(308) 865-2577
Mailing address
516 W 39TH ST, SUITE D TOWER PLAZA, KEARNEY, NE 68845-2881
(308) 865-2577
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01
—
NE
01
—
3663
BLUE CROSS BLUE SHIELD
—
01
—
5400
BLUE CROSS BLUE SHIELD
—
Enumeration date
10/21/2009
Last updated
01/03/2018
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