Michael Fredrick Tillery, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

12007704A Issued in IN

Practice address

3410 N High School Rd
Suite B
Indianapolis, IN 46224-1742

Phone

(317) 291-8957

Fax

(317) 291-2115

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

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.

• Michael F. Tillery DDS & Associates PC

  • General Practice Dentistry
  • Indianapolis, IN
  • NPI 1609286061
  NPD (past) Authorized official

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356494462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3410 N HIGH SCHOOL RD",
            "address_2": "SUITE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462241742",
            "telephone_number": "317-291-8957",
            "fax_number": "317-291-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 N HIGH SCHOOL RD",
            "address_2": "SUITE B",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462241742",
            "telephone_number": "317-291-8957",
            "fax_number": "317-291-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLERY",
        "first_name": "MICHAEL",
        "middle_name": "FREDRICK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12007704A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jakyra Tilford, RBT
• Mary Jo Tilford, RN
• Chelsea Till, OD
• Kiera Till
• Melissa Ann Tillar, OTR
• Samantha Tilley
• Darnesia Alyse Tillis, LMHCA
• Justin J Tillis
• Chloe Tillman, D.C.
• Julie A Tillman, MD

• Dentist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.