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General NPI Number Information
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NPI Number | 1992876213
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Entity Type | Organization
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Legal Business Name | MICHAEL S TILSON, DDS MS INC
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 06/02/2014
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Provider Practice Location Address
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Address Line | 1545 BRICE RD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068
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Country | US
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Telephone | 614-863-4664
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Fax | 614-751-1792
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Provider Business Mailing Address
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Address Line | 1545 BRICE RD
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City | REYNOLDSBURG
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State | OH
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Zip | 43068
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Country | US
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Telephone | 614-863-4664
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Fax | 614-751-1792
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL S TILSON
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Credential | DDS MS
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Telephone | 614-863-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30020344
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License Number State | OH
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