Provider Demographics
NPI:1740628833
Name:LILLMARS, ANNA HALLIE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:HALLIE
Last Name:LILLMARS
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 1:227 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-1952
Mailing Address - Country:US
Mailing Address - Phone:636-931-2700
Mailing Address - Fax:636-931-5304
Practice Address - Street 1:4 HICKORY RIDGE RD
Practice Address - Street 2:STE 600
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5100
Practice Address - Country:US
Practice Address - Phone:636-481-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013016373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist