NPIMap

Organization Active NPI

Tillery Dental Clinics, P.a.

  • General Practice Dentistry
  • Laurel, MS
National Provider Identifier
1376656041
Registry record updated Jan 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
MS133268 Issued in MS
Legal business name
TILLERY DENTAL CLINICS, P.A.
Practice address
1508 W 10TH St
Laurel, MS 39440-2668
Phone
(601) 428-6093
Fax
(601) 428-6096
NPI assigned
Aug 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2008

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

Authorized official

Name
Douglas W. Tillery
Title
Owner
Phone
(601) 428-6093

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X MS133268 MS Primary

Addresses

Primary practice location

1508 W 10TH St
Laurel, MS 39440-2668

Mailing address

1508 W 10TH St
Laurel, MS 39440-2668
Phone (601) 428-6093

National Provider Directory

National Provider Directory
Tax ID family
Tillery Dental Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1508 W 10th St
Laurel, MS 39440
Phone (601) 428-6093

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199318400000",
    "number": "1376656041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1508 W 10TH ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402668",
            "telephone_number": "601-428-6093",
            "fax_number": "601-428-6096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1508 W 10TH ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394402668",
            "telephone_number": "601-428-6093",
            "fax_number": "601-428-6096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLERY DENTAL CLINICS, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-01-03",
        "status": "A",
        "authorized_official_last_name": "TILLERY",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-428-6093"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "MS133268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.