Tillery Dental Clinic

NPI 1205011608 - Dentist - 122300000X

NPI Details
NPI 1205011608
Enumeration Date 01/03/2008
Last Updated 01/03/2008
Entity Type Healthcare Provider
Active Over 8 years ago
Authorized Information
Name DOUGLAS W DOUGLAS
Position OWNER
Phone (601) 785-4770
Fax (601) 785-4831
Practice Location
411 WILLIS ST
TAYLORSVILLE MS, 39168, US
Phone (601) 785-4770
Fax (601) 785-4831
Business Location
PO BOX 559
TAYLORSVILLE MS, 39168-0559, US
Phone (601) 785-4770
Fax (601) 785-4831
Toxanomy
Taxonomy Code 122300000X
License State Mississippi
License Number MS133268
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According to our database, Tillery Dental Clinic NPI is 1205011608, taxonomy code is 122300000X and license number is MS133268, license state is located at Mississippi. Tillery Dental Clinic physically located at 411 Willis St, Taylorsville MS, 39168. NPI Number 1033115704 has the healthcare provider type.

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1205011608 NPI number is provided on an as is basis without warranty of any kind. 1205011608 is maintained by the National Plan & Provider Enumeration System. The contents of Tillery Dental Clinic are for informational purposes only.