| Tillery Dental Clinics, P.a. | |
|
1508 W 10th St Laurel MS 39440-2668 | |
| (601) 428-6093 | |
| (601) 428-6096 |
| Full Name | Tillery Dental Clinics, P.a. |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1508 W 10th St, Laurel, 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 Clinics, P.a. 1508 W 10th St Laurel MS 39440-2668 Ph: (601) 428-6093 | Tillery Dental Clinics, P.a. 1508 W 10th St Laurel MS 39440-2668 Ph: (601) 428-6093 |
| NPI Number | 1376656041 |
|---|---|
| Provider Enumeration Date | 08/16/2006 |
| Last Update Date | 01/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376656041 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | MS133268 (Mississippi) | Primary |
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