Provider Demographics
NPI:1881822625
Name:TILLMANN, WESLEY FRIEDRICH (DMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:FRIEDRICH
Last Name:TILLMANN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5872 S 900 E
Mailing Address - Street 2:SUITE # 202
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1676
Mailing Address - Country:US
Mailing Address - Phone:801-281-8433
Mailing Address - Fax:
Practice Address - Street 1:5872 S 900 E
Practice Address - Street 2:SUITE # 202
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-1676
Practice Address - Country:US
Practice Address - Phone:801-281-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7393738-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice