Provider Demographics
NPI:1326159740
Name:RICHARD L. TILLMAN DMD PC
Entity Type:Organization
Organization Name:RICHARD L. TILLMAN DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-223-9725
Mailing Address - Street 1:833 SW 11TH AVE
Mailing Address - Street 2:SUITE #600
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2125
Mailing Address - Country:US
Mailing Address - Phone:503-223-9725
Mailing Address - Fax:503-223-3578
Practice Address - Street 1:833 SW 11TH AVE
Practice Address - Street 2:SUITE #600
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2125
Practice Address - Country:US
Practice Address - Phone:503-223-9725
Practice Address - Fax:503-223-3578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty