Provider Demographics
NPI:1235341744
Name:LLOYD V. TILT, DDS,MS,PC
Entity Type:Organization
Organization Name:LLOYD V. TILT, DDS,MS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:V
Authorized Official - Last Name:TILT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:801-394-6651
Mailing Address - Street 1:3590 HARRISON BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2403
Mailing Address - Country:US
Mailing Address - Phone:801-394-6651
Mailing Address - Fax:801-394-2557
Practice Address - Street 1:3590 HARRISON BLVD
Practice Address - Street 2:STE 3
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2403
Practice Address - Country:US
Practice Address - Phone:801-394-6651
Practice Address - Fax:801-394-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1377129922261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental