Provider Demographics
NPI:1528025269
Name:LILLY, JAMES DAVID JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:LILLY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13651
Mailing Address - Street 2:7834 FOREST HILL AVE
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-8651
Mailing Address - Country:US
Mailing Address - Phone:804-320-0773
Mailing Address - Fax:804-320-0773
Practice Address - Street 1:7834 FOREST HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-8651
Practice Address - Country:US
Practice Address - Phone:804-320-0773
Practice Address - Fax:804-320-0773
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401004665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist