Provider Demographics
NPI:1750857538
Name:LISA S TILTON DDS INC.
Entity Type:Organization
Organization Name:LISA S TILTON DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TILTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-962-5545
Mailing Address - Street 1:17742 BEACH BLVD STE 315
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6853
Mailing Address - Country:US
Mailing Address - Phone:714-962-5545
Mailing Address - Fax:714-594-0252
Practice Address - Street 1:17742 BEACH BLVD STE 315
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6853
Practice Address - Country:US
Practice Address - Phone:714-962-5545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty