Provider Demographics
NPI:1255427555
Name:LILLER, THOMAS J (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:LILLER
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 1:27476 DETROIT RD STE 205
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2383
Mailing Address - Country:US
Mailing Address - Phone:440-250-8898
Mailing Address - Fax:440-250-8979
Practice Address - Street 1:27476 DETROIT RD STE 205
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2383
Practice Address - Country:US
Practice Address - Phone:440-250-8898
Practice Address - Fax:440-250-8979
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14848122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU16423Medicare UPIN
OHL10690861Medicare ID - Type Unspecified