Provider Demographics
NPI:1053632562
Name:LILLARD, JONATHAN F SR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:F
Last Name:LILLARD
Suffix:SR
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 1:2250 CLARENDON BLVD
Mailing Address - Street 2:STORE F
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-3332
Mailing Address - Country:US
Mailing Address - Phone:703-841-0300
Mailing Address - Fax:
Practice Address - Street 1:2250 CLARENDON BLVD
Practice Address - Street 2:STORE F
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201
Practice Address - Country:US
Practice Address - Phone:703-841-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA4551VA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice