Healthcare Provider Details

I. General information

NPI: 1164490553
Provider Name (Legal Business Name): ANTHONY J TILELLI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

336 COWESETT AVE
WEST WARWICK RI
02893
US

IV. Provider business mailing address

336 COWESETT AVE
WEST WARWICK RI
02893
US

V. Phone/Fax

Practice location:
  • Phone: 401-828-2400
  • Fax: 401-828-0051
Mailing address:
  • Phone: 401-828-2400
  • Fax: 401-828-0051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1731
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: