Provider Demographics
NPI:1902905805
Name:MCALLISTER, MICHAEL TILLETT JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TILLETT
Last Name:MCALLISTER
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:7929 REUNION ROAD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411
Mailing Address - Country:US
Mailing Address - Phone:910-686-2477
Mailing Address - Fax:910-259-3734
Practice Address - Street 1:745 US HIGHWAY 117 S
Practice Address - Street 2:C
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-7746
Practice Address - Country:US
Practice Address - Phone:910-259-3733
Practice Address - Fax:910-259-3734
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2010-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC77851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902U4Medicaid