Provider Demographics
NPI:1225017973
Name:TILTON, JON W (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:W
Last Name:TILTON
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 1:404 S EDGEMOOR ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1631
Mailing Address - Country:US
Mailing Address - Phone:316-684-8440
Mailing Address - Fax:316-686-7218
Practice Address - Street 1:404 S EDGEMOOR ST
Practice Address - Street 2:SUITE 320
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1631
Practice Address - Country:US
Practice Address - Phone:316-684-8440
Practice Address - Fax:316-686-7218
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS51521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice