Provider Demographics
NPI:1093951626
Name:TILLMAN DENTAL & ORTHODONTICS
Entity Type:Organization
Organization Name:TILLMAN DENTAL & ORTHODONTICS
Other - Org Name:ALMEDA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-294-5774
Mailing Address - Street 1:5701 KIAM ST UNIT F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-1141
Mailing Address - Country:US
Mailing Address - Phone:713-294-5774
Mailing Address - Fax:
Practice Address - Street 1:2280 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4224
Practice Address - Country:US
Practice Address - Phone:713-799-1400
Practice Address - Fax:713-799-1751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-03
Last Update Date:2009-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23294261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental