Provider Demographics
NPI:1275660052
Name:JEFFREY M. LILYHORN D.D.S., P.C.
Entity Type:Organization
Organization Name:JEFFREY M. LILYHORN D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:LILYHORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:775-786-2011
Mailing Address - Street 1:3575 GRANT DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5301
Mailing Address - Country:US
Mailing Address - Phone:775-828-4070
Mailing Address - Fax:
Practice Address - Street 1:3575 GRANT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5301
Practice Address - Country:US
Practice Address - Phone:775-828-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1056261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental