| Entity Name: | E. A. TILLMAN & ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 30 Oct 2000 (24 years ago) |
| Document Number: | P00000102552 |
| FEI/EIN Number | 593681855 |
| Address: | 285 N. FERDON BOULEVARD, CRESTVIEW, FL, 32536 |
| Mail Address: | 285 N. FERDON BOULEVARD, CRESTVIEW, FL, 32536 |
| ZIP code: | 32536 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1063509222 | 2006-10-09 | 2020-08-22 | 285 N FERDON BLVD, CRESTVIEW, FL, 325362751, US | 285 N FERDON BLVD, CRESTVIEW, FL, 325362751, US | |||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||
| Phone | +1 850-682-2408 |
| Fax | 8506828755 |
Authorized person
| Name | E A TILLMAN |
| Role | PRESIDENT |
| Phone | 8506822408 |
Taxonomy
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 9341 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 1223G0001X - General Practice Dentistry |
| License Number | 3915 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | UNITED CONCORDIA |
| Number | 977588 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TILLMAN E A | Agent | 285 N. FERDON BOULEVARD, CRESTVIEW, FL, 32536 |
| Name | Role | Address |
|---|---|---|
| TILLMAN E A | President | 285 N FERDON BLVD, CRESTVIEW, FL, 32536 |
| Name | Role | Address |
|---|---|---|
| ALLEN MARY | Secretary | 1407 GREENWOOD RD, BAKER, FL, 32531 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2019-08-20 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
