Gregg Harrison Tillman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

15104 Issued in TX

Practice address

4900 Overton Ridge Blvd
Fort Worth, TX 76132-1911

Phone

(817) 292-1904

Fax

(817) 294-3297

NPI assigned

Aug 23, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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 TX

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

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821105297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4900 OVERTON RIDGE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761321911",
            "telephone_number": "817-292-1904",
            "fax_number": "817-294-3297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 OVERTON RIDGE BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761321911",
            "telephone_number": "817-292-1904",
            "fax_number": "817-294-3297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "GREGG",
        "middle_name": "HARRISON",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "15104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynne R Tilkin, DO
• Marva J Tilleman
• Celya N Tilley, FNP-BC
• Jo Ann Tilley, CPNP
• Julia Tillie, L.C.S.W.
• Katherine Kelle Tillman, APRN ACNS-BC
• Michael David Tillman, DDS
• Tricia Tillman
• Cally Lynn Tilly, LPC
• Tim P Kret OD, PA (1st Eye Care)

• General Practice Dentistry in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• General Practice Dentistry in Texas

• 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.