Provider Demographics
NPI:1730485657
Name:JOHN TILLNER DENTAL CORPORATION
Entity Type:Organization
Organization Name:JOHN TILLNER DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:TILLNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-482-6774
Mailing Address - Street 1:752 MEDICAL CENTER CT
Mailing Address - Street 2:STE 205
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6658
Mailing Address - Country:US
Mailing Address - Phone:619-482-6774
Mailing Address - Fax:619-482-7637
Practice Address - Street 1:752 MEDICAL CENTER CT
Practice Address - Street 2:STE 205
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6658
Practice Address - Country:US
Practice Address - Phone:619-482-6774
Practice Address - Fax:619-482-7637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty