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General NPI Number Information
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NPI Number | 1093951626
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Entity Type | Organization
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Legal Business Name | TILLMAN DENTAL & ORTHODONTICS
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Dates
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Enumeration Date | 01/03/2009
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Last Update Date | 01/03/2009
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Provider Practice Location Address
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Address Line | 2280 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4224
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Country | US
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Telephone | 713-799-1400
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Fax | 713-799-1751
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Provider Business Mailing Address
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Address Line | 5701 KIAM ST UNIT F
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City | HOUSTON
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State | TX
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Zip | 77007-1141
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Country | US
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Telephone | 713-294-5774
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DEREK TILLMAN
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Credential | D.M.D.
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Telephone | 713-294-5774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 23294
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License Number State | TX
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