Provider Demographics
NPI:1417181579
Name:FEDER, LILLIAN MARY (DMD)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:MARY
Last Name:FEDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BECKLEY PLZ
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-2221
Mailing Address - Country:US
Mailing Address - Phone:304-253-0506
Mailing Address - Fax:
Practice Address - Street 1:114 BECKLEY PLZ
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-2221
Practice Address - Country:US
Practice Address - Phone:304-253-0506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-05
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3981122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist