Provider Demographics
NPI:1568570877
Name:TILLER, THOMAS ALTON (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALTON
Last Name:TILLER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Mailing Address - Street 1:315 N SAN SABA
Mailing Address - Street 2:STE. 202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3154
Mailing Address - Country:US
Mailing Address - Phone:210-354-3131
Mailing Address - Fax:210-354-3133
Practice Address - Street 1:315 N SAN SABA
Practice Address - Street 2:STE. 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-354-3131
Practice Address - Fax:210-354-3133
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics