Provider Demographics
NPI:1750513347
Name:TILLILIE, JAMES ANTHONY (DMD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTHONY
Last Name:TILLILIE
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 1:2 E WOODLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2913
Mailing Address - Country:US
Mailing Address - Phone:610-544-0120
Mailing Address - Fax:610-544-1563
Practice Address - Street 1:2 E WOODLAND AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2913
Practice Address - Country:US
Practice Address - Phone:610-544-0120
Practice Address - Fax:610-544-1563
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017868L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics