MEDICARE: MRS. LISA S TILTON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	48039	CA

General Provider Information

NPI Number	:	1427066711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA S TILTON D.D.S.

Provider Business Mailing Address
First Line	:	9182 WILLHELM CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-2334
Country	:	US
Telephone Number	:	714-968-5652
Fax Number	:	714-594-0252

Provider Business Practice Location Address
First Line	:	18516 BEACH BLVD
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-2018
Country	:	US
Telephone Number	:	714-962-5545
Fax Number	:	714-594-0252

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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