Organization
TILLERY GROUP PA
Active
Organization
TILLERY GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DON E TILLERY JR. DMD (OWNER AND SURGEON)
(407) 628-5400
Entity
Organization
Contact information
Practice address
800 W MORSE BLVD, SUITE 2, WINTER PARK, FL 32789-3797
(407) 628-5400
(407) 628-5389
Mailing address
800 W MORSE BLVD, SUITE 2, WINTER PARK, FL 32789-3797
(407) 628-5400
(407) 628-5389
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10178
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
16103
FL
Other
Enumeration date
04/12/2007
Last updated
09/23/2014
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