Provider Demographics
NPI:1073205019
Name:CREGAN, LILLIAN ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:ROSE
Last Name:CREGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1487 CHELSEA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-2312
Mailing Address - Country:US
Mailing Address - Phone:651-262-3262
Mailing Address - Fax:
Practice Address - Street 1:2096 FORD PKWY
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1813
Practice Address - Country:US
Practice Address - Phone:165-123-7991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND148831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice