Provider Demographics
NPI:1235663634
Name:SPIEGEL, LILY
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:SPIEGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 JOHN MAHAR HWY UNIT 3302
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-6561
Mailing Address - Country:US
Mailing Address - Phone:781-380-1462
Mailing Address - Fax:
Practice Address - Street 1:416 JOHN MAHAR HWY UNIT 3302
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6561
Practice Address - Country:US
Practice Address - Phone:781-380-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH13468124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist