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NPI Code Detail

MEDICARE: MARISOL SASTOQUE-TILLER DDS

MEDICARE: MARISOL SASTOQUE-TILLER DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry10141NC

General Provider Information

NPI Number : 1306250154
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARISOL SASTOQUE-TILLER DDS
Provider Business Mailing Address
First Line : 11030 GOLF LINKS DR STE 201
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8047
Country : US
Telephone Number : 704-321-0414
Fax Number :
Provider Business Practice Location Address
First Line : 11030 GOLF LINKS DR STE 201
Second Line :
City : CHARLOTTE
State : NC
Zip : 28277-8047
Country : US
Telephone Number : 704-321-0414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2014
Last Update Date : 09/16/2022

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Directions to “ MARISOL SASTOQUE-TILLER DDS” Practice Location

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