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General NPI Number Information
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NPI Number | 1871620153
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Entity Type | Individual
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Provider Name | ADA S TILLER D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14205 N MO PAC EXPY SUITE 100
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City | AUSTIN
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State | TX
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Zip | 78728-6527
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Country | US
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Telephone | 512-218-1130
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Fax | 512-218-4423
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Provider Business Mailing Address
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Address Line | 2222 HAMLET CIR
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City | ROUND ROCK
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State | TX
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Zip | 78664-6132
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Country | US
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Telephone | 512-218-1130
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Fax | 512-218-4423
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17680
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License Number State | TX
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