Provider Demographics
NPI:1942344940
Name:TILMAN, NATHAN WAYNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:WAYNE
Last Name:TILMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 BULL ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-2701
Mailing Address - Country:US
Mailing Address - Phone:401-846-3801
Mailing Address - Fax:401-846-3843
Practice Address - Street 1:3 BULL ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-2701
Practice Address - Country:US
Practice Address - Phone:401-846-3801
Practice Address - Fax:401-846-3843
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN029281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice