Dr. John Barry Tillis, d.m.d.
Dentist in Rockford, IL. Individual provider (NPI-1).
NPI number1790728236
StatusActive
Last updated in NPPESAug 28, 2007
Details
- NPI
- 1790728236
- Entity type
- Individual (NPI-1)
- Name
- Dr. John Barry Tillis
- Credential
- d.m.d.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Jun 13, 2006
- Last updated
- Aug 28, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 122300000X | Dentist | 019-019019783 | IL | Yes |
Practice location
7117 Crimson Ridge DrSuite 5
Rockford, IL 61107-6208
Phone 815-395-0327
Mailing address
7117 Crimson Ridge Dr.Suite 5
Rockford, IL 61107
Phone 815-395-0327
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