Basic Information
| Provider Information | |||||||||
| NPI: | 1952399677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LILLARD | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17808 87TH AVE E | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983756244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2538754611 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 690 BARNES BLVD | ||||||||
| Address2: | |||||||||
| City: | MCCHORD AFB | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984381303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539825505 | ||||||||
| FaxNumber: | 2539823749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 11,105 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.