Provider Demographics
NPI:1588610901
Name:BN TILDS PC
Entity Type:Organization
Organization Name:BN TILDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:TILDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-489-9595
Mailing Address - Street 1:27650 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-3310
Mailing Address - Country:US
Mailing Address - Phone:248-489-9595
Mailing Address - Fax:248-489-5971
Practice Address - Street 1:27650 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3310
Practice Address - Country:US
Practice Address - Phone:248-489-9595
Practice Address - Fax:248-489-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI009570261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental