Provider Demographics
NPI:1538276761
Name:TILLISS, LARRY (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:TILLISS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 INVERNESS DR E
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5137
Mailing Address - Country:US
Mailing Address - Phone:303-723-0446
Mailing Address - Fax:
Practice Address - Street 1:125 INVERNESS DR E
Practice Address - Street 2:SUITE 350
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5137
Practice Address - Country:US
Practice Address - Phone:303-723-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice