Provider Demographics
NPI:1831101666
Name:LILYHORN, JEFFREY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:LILYHORN
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 1:3030 RUSTIC MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3849
Mailing Address - Country:US
Mailing Address - Phone:775-825-4070
Mailing Address - Fax:
Practice Address - Street 1:3575 GRANT DR
Practice Address - Street 2:SUITE 1
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5301
Practice Address - Country:US
Practice Address - Phone:775-825-4070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice