Provider Demographics
NPI:1508070640
Name:LILLIAN MILLER DENTAL
Entity Type:Organization
Organization Name:LILLIAN MILLER DENTAL
Other - Org Name:MCCART FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:ERANGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KANEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-489-1217
Mailing Address - Street 1:2430 S INTERSTATE 35 E
Mailing Address - Street 2:STE 210
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-4986
Mailing Address - Country:US
Mailing Address - Phone:940-387-2214
Mailing Address - Fax:940-387-2212
Practice Address - Street 1:318 E MCCART ST STE 100
Practice Address - Street 2:
Practice Address - City:KRUM
Practice Address - State:TX
Practice Address - Zip Code:76249-5645
Practice Address - Country:US
Practice Address - Phone:940-398-3135
Practice Address - Fax:806-639-8710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20062122300000X
TX22256122300000X
TX22427122300000X
TX21050122300000X
TX214561223X0400X
261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental