Provider Demographics
NPI:1285043166
Name:TILLMAN, ANDREW TREVOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TREVOR
Last Name:TILLMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 OAKWAY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5603
Mailing Address - Country:US
Mailing Address - Phone:541-484-1955
Mailing Address - Fax:
Practice Address - Street 1:86479 N MODESTO DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97402-9008
Practice Address - Country:US
Practice Address - Phone:541-729-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist