Provider Demographics
NPI:1720135874
Name:LANDRIGAN, LILLIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LILLIAN
Middle Name:
Last Name:LANDRIGAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-2557
Mailing Address - Country:US
Mailing Address - Phone:901-409-0496
Mailing Address - Fax:
Practice Address - Street 1:1920 KIRBY PKWY STE 200
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3697
Practice Address - Country:US
Practice Address - Phone:901-409-0496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR34131223G0001X
TNDS4254122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice