Provider Demographics
NPI:1306950274
Name:TILLERY, DON E JR (DMD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:E
Last Name:TILLERY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:800 W MORSE BLVD
Mailing Address - Street 2:STE 2
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789
Mailing Address - Country:US
Mailing Address - Phone:407-628-5400
Mailing Address - Fax:407-628-5389
Practice Address - Street 1:800 W MORSE BLVD
Practice Address - Street 2:STE 2
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789
Practice Address - Country:US
Practice Address - Phone:407-628-5400
Practice Address - Fax:407-628-5389
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDN101781223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery