Provider Demographics
NPI:1235398934
Name:STEVEN A. TILLISS DDS MS PC
Entity Type:Organization
Organization Name:STEVEN A. TILLISS DDS MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TILLISS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:303-779-6924
Mailing Address - Street 1:8200 E BELLEVIEW AVE
Mailing Address - Street 2:450E
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2803
Mailing Address - Country:US
Mailing Address - Phone:303-779-6924
Mailing Address - Fax:303-741-2777
Practice Address - Street 1:8200 E BELLEVIEW AVE
Practice Address - Street 2:450E
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2803
Practice Address - Country:US
Practice Address - Phone:303-779-6924
Practice Address - Fax:303-741-2777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1042951223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty