Provider Demographics
NPI:1831460872
Name:HAMBLIN, LILIA V (DENTAL HYGIENIST)
Entity Type:Individual
Prefix:MRS
First Name:LILIA
Middle Name:V
Last Name:HAMBLIN
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6279 NE CARILLION DR UNIT 103
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-8092
Mailing Address - Country:US
Mailing Address - Phone:503-729-2864
Mailing Address - Fax:
Practice Address - Street 1:6279 NE CARILLION DR UNIT 103
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8092
Practice Address - Country:US
Practice Address - Phone:503-729-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5722124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist