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General NPI Number Information
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NPI Number | 1235398934
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Entity Type | Organization
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Legal Business Name | STEVEN A. TILLISS DDS MS PC
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 8200 E BELLEVIEW AVE 450E
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2803
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Country | US
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Telephone | 303-779-6924
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Fax | 303-741-2777
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Provider Business Mailing Address
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Address Line | 8200 E BELLEVIEW AVE 450E
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City | GREENWOOD VILLAGE
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State | CO
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Zip | 80111-2803
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Country | US
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Telephone | 303-779-6924
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Fax | 303-741-2777
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. STEVE ALAN TILLISS
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Credential | DDS MS
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Telephone | 303-779-6924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 104295
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License Number State | CO
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