Provider Demographics
NPI:1437111523
Name:CONNER, LILLIAN MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:MICHELLE
Last Name:CONNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4805 PARK RD
Mailing Address - Street 2:#223
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3803
Mailing Address - Country:US
Mailing Address - Phone:704-527-1228
Mailing Address - Fax:704-341-6193
Practice Address - Street 1:4805 PARK RD
Practice Address - Street 2:#223
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3803
Practice Address - Country:US
Practice Address - Phone:704-527-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice