Provider Demographics
NPI:1013191402
Name:TILSON, MICHAEL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:TILSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 BRICE RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2307
Mailing Address - Country:US
Mailing Address - Phone:614-863-4664
Mailing Address - Fax:614-751-1792
Practice Address - Street 1:1545 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2307
Practice Address - Country:US
Practice Address - Phone:614-863-4664
Practice Address - Fax:614-751-1792
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30203441223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics