Provider Demographics
NPI:1508834649
Name:LILLANEY, SANTOSH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANTOSH
Middle Name:
Last Name:LILLANEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-3107
Mailing Address - Country:US
Mailing Address - Phone:718-827-2311
Mailing Address - Fax:718-348-9801
Practice Address - Street 1:551 CRESCENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-3107
Practice Address - Country:US
Practice Address - Phone:718-827-2311
Practice Address - Fax:718-348-9801
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0398921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00954421Medicaid