1720700669 NPI number — MARLBOROUGH VILLAGE ORTHODONTICS

Table of content: DR. DAVID ARNOLD TILLMAN M.D. (NPI 1235457482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720700669 NPI number — MARLBOROUGH VILLAGE ORTHODONTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARLBOROUGH VILLAGE ORTHODONTICS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720700669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14300 RIDGE VIEW LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-280-0968
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5098 BROWN STATION ROAD SUITE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-326-3738
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
ADRIAN
Authorized Official Middle Name:
JOHNSTON
Authorized Official Title or Position:
DENTIST/OWNER
Authorized Official Telephone Number:
443-280-0968

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)