| Tillery Group Pa | |
|
800 W Morse Blvd Suite 2 Winter Park FL 32789-3797 | |
| (407) 628-5400 | |
| (407) 628-5389 |
| Full Name | Tillery Group Pa |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 800 W Morse Blvd, Winter Park, Florida |
| Authorized Official Name and Position | Don E Tillery (OWNER AND SURGEON) |
| Authorized Official Contact | 4076285400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tillery Group Pa 800 W Morse Blvd Suite 2 Winter Park FL 32789-3797 Ph: (407) 628-5400 | Tillery Group Pa 800 W Morse Blvd Suite 2 Winter Park FL 32789-3797 Ph: (407) 628-5400 |
| NPI Number | 1902020118 |
|---|---|
| Provider Enumeration Date | 04/12/2007 |
| Last Update Date | 09/23/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902020118 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 10178 (Florida) | Primary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 16103 (Florida) | Secondary |
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