Provider Demographics
NPI:1477693356
Name:KOEFF, LILLY T (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LILLY
Middle Name:T
Last Name:KOEFF
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 1:3435 OCEAN PARK BLVD
Mailing Address - Street 2:S 205
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405
Mailing Address - Country:US
Mailing Address - Phone:310-396-9969
Mailing Address - Fax:310-396-8830
Practice Address - Street 1:3435 OCEAN PARK BLVD
Practice Address - Street 2:S 205
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405
Practice Address - Country:US
Practice Address - Phone:310-396-9969
Practice Address - Fax:310-396-8830
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist