Provider Demographics
NPI:1821206822
Name:LILAC, PATRICIA JACQUELINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JACQUELINE
Last Name:LILAC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:LILAC
Other - Last Name:YOUNGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:133 E MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2157
Mailing Address - Country:US
Mailing Address - Phone:517-265-7411
Mailing Address - Fax:517-263-1050
Practice Address - Street 1:133 E MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2157
Practice Address - Country:US
Practice Address - Phone:517-265-7411
Practice Address - Fax:517-263-1050
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI141051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice