| Tillery Dental Clinic | |
|
6032 U S Highway 98 Hattiesburg MS 39402-8861 | |
| (601) 264-0333 | |
| (601) 264-0821 |
| Full Name | Tillery Dental Clinic |
|---|---|
| Speciality | Dentist |
| Location | 6032 U S Highway 98, Hattiesburg, Mississippi |
| Authorized Official Name and Position | Douglas W Tillery (OWNER) |
| Authorized Official Contact | 6014286093 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tillery Dental Clinic 6032 U S Highway 98 Hattiesburg MS 39402-8861 Ph: (601) 264-0333 | Tillery Dental Clinic 6032 U S Highway 98 Hattiesburg MS 39402-8861 Ph: (601) 264-0333 |
| NPI Number | 1528240330 |
|---|---|
| Provider Enumeration Date | 12/04/2007 |
| Last Update Date | 12/04/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528240330 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | MS133268 (Mississippi) | Primary |
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