Provider Demographics
NPI:1295813343
Name:MICHAEL P LILLMARS DDS DOUGLAS A CARANO DDS LLC
Entity Type:Organization
Organization Name:MICHAEL P LILLMARS DDS DOUGLAS A CARANO DDS LLC
Other - Org Name:CEDAR HILL DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-274-0447
Mailing Address - Street 1:7056 HIGHWAY BB
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63016-2301
Mailing Address - Country:US
Mailing Address - Phone:636-274-0447
Mailing Address - Fax:
Practice Address - Street 1:7056 HIGHWAY BB
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:MO
Practice Address - Zip Code:63016-2301
Practice Address - Country:US
Practice Address - Phone:636-274-0447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO14295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty