Matthew David Tillman, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

940 Issued in SC

Practice address

4410 Highway 17 Unit B6
Murrells Inlet, SC 29576-6434

Phone

(423) 741-9078

NPI assigned

Jun 27, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Seaside Pediatric Dental Associates

  • Pediatric Dentistry
  • Murrells Inlet, SC
  • NPI 1578084331
  NPD Authorized official
• Universal Dental Assoc Dso LLC

  • Dentist
  • Johnson City, TN
  • NPI 1467758227
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073809133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4410 HIGHWAY 17 UNIT B6",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295766434",
            "telephone_number": "423-741-9078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4410 HIGHWAY 17 UNIT B6",
            "city": "MURRELLS INLET",
            "state": "SC",
            "postal_code": "295766434",
            "telephone_number": "423-741-9078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "712 W Walnut St",
            "address_purpose": "LOCATION",
            "city": "Johnson City",
            "state": "TN",
            "postal_code": "376046524",
            "country_code": "US",
            "telephone_number": "423-928-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "MATTHEW",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-27",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "7129",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TN",
            "license": "9343",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Maldonado Thompson, MD
• Patricia Thorn
• Taylor Chesser Thrash, DO
• Tidelands Health
• Bradley B Tiller, D.M.D.
• Ella Tisdale, CRNA
• Angela Crystell Todd Johnson, PTA
• Barbara A. Todd, DMD
• Brandi Johnson Todd
• Portia Quantee Toon, FNP

• Pediatric Dentistry in Murrells Inlet, SC
• Providers in Murrells Inlet, SC by specialty
• Pediatric Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.