Provider Demographics
NPI:1154496644
Name:TILLEY, MICHAEL SHAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SHAY
Last Name:TILLEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1754 S RUTHERFORD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-0721
Mailing Address - Country:US
Mailing Address - Phone:615-849-1292
Mailing Address - Fax:615-849-1293
Practice Address - Street 1:1754 S RUTHERFORD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-0721
Practice Address - Country:US
Practice Address - Phone:615-849-1292
Practice Address - Fax:615-849-1293
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16224122300000X
TN7475122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist