Provider Demographics
NPI:1225391154
Name:SANTANA, LILLELENNY (DMD, MSC, CAGS)
Entity Type:Individual
Prefix:DR
First Name:LILLELENNY
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:DMD, MSC, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1327 SNUG HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:CASSELBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32707-6719
Mailing Address - Country:US
Mailing Address - Phone:617-610-9024
Mailing Address - Fax:
Practice Address - Street 1:1327 SNUG HARBOR DR
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-6719
Practice Address - Country:US
Practice Address - Phone:617-610-9024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-15
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560231223X0400X
FLDN232061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics