Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0001X | Dental Public Health | 3380 | AR |
Y | 1223D0001X | Dental Public Health | DEN-DEN-LIC- 11602 | MT |
N | 1223G0001X | General Practice | DS022410L | PA |
N | 213EG0000X | General Practice | DS022410L | PA |
NPI | 1245286095 |
---|---|
Provider Name | Ronald Tilgner |
First Address | Havre, MT 59501-3649 |
Second Address | Havre, MT 59501-3649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 15/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1007456580009 | (05) | PA |