MEDICARE: BN TILDS PC

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
1	261QD0000X	Dental Clinic/Center	009570	MI

General Provider Information

NPI Number	:	1588610901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BN TILDS PC

Provider Business Mailing Address
First Line	:	27650 FARMINGTON RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3310
Country	:	US
Telephone Number	:	248-489-9595
Fax Number	:	248-489-5971

Provider Business Practice Location Address
First Line	:	27650 FARMINGTON RD
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-3310
Country	:	US
Telephone Number	:	248-489-9595
Fax Number	:	248-489-5971

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY N. TILDS
Credential	:	DDS
Telephone Number	:	248-489-9595

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	08/22/2020

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