Provider Demographics
NPI:1598821258
Name:LICHLITER, WAYNE D (DDS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:D
Last Name:LICHLITER
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 1:2176 WEST ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3829
Mailing Address - Country:US
Mailing Address - Phone:901-754-2967
Mailing Address - Fax:901-755-2422
Practice Address - Street 1:2176 WEST ST
Practice Address - Street 2:SUITE 302
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3829
Practice Address - Country:US
Practice Address - Phone:901-754-2967
Practice Address - Fax:901-755-2422
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist