Provider Demographics
NPI:1598995227
Name:WORKMAN, LILY AYN
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:AYN
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9727 TOUCHTON RD
Mailing Address - Street 2:APT 909
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-8229
Mailing Address - Country:US
Mailing Address - Phone:760-271-4700
Mailing Address - Fax:
Practice Address - Street 1:9727 TOUCHTON RD
Practice Address - Street 2:APT 909
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-8229
Practice Address - Country:US
Practice Address - Phone:760-271-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA567861223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics