| NPI | 1902020118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DON E TILLERY Owner And Surgeon 407-628-5400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL 10178) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL 16103) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2014-09-23 |