Basic Information
| Provider Information | |||||||||
| NPI: | 1245286095 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TILGNER | ||||||||
| FirstName: | RONALD | ||||||||
| MiddleName: | |||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 4TH ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595013649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063954305 | ||||||||
| FaxNumber: | 4063955643 | ||||||||
| Practice Location | |||||||||
| Address1: | 521 4TH ST | ||||||||
| Address2: | |||||||||
| City: | HAVRE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 595013649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063954305 | ||||||||
| FaxNumber: | 4063955643 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DS022410L | PA | N | Dental Providers | Dentist | General Practice | 1223D0001X | 3380 | AR | N | Dental Providers | Dentist | Dental Public Health | 1223D0001X | DEN-DEN-LIC- 11602 | MT | Y | Dental Providers | Dentist | Dental Public Health |
ID Information
| ID | Type | State | Issuer | Description | 1007456580009 | 05 | PA | MEDICAID |