Provider Demographics
NPI:1548604739
Name:TILLMAN'S CORNER DENTAL, P.C.
Entity Type:Organization
Organization Name:TILLMAN'S CORNER DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:REINDL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-660-1400
Mailing Address - Street 1:5659 THREE NOTCH RD.
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619
Mailing Address - Country:US
Mailing Address - Phone:251-660-1400
Mailing Address - Fax:251-660-1409
Practice Address - Street 1:5659 THREE NOTCH RD.
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619
Practice Address - Country:US
Practice Address - Phone:251-660-1400
Practice Address - Fax:251-660-1409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL39641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty