Provider Demographics
NPI:1952399677
Name:LILLARD, TIMOTHY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LYNN
Last Name:LILLARD
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 1:17808 87TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6244
Mailing Address - Country:US
Mailing Address - Phone:253-875-4611
Mailing Address - Fax:
Practice Address - Street 1:690 BARNES BLVD
Practice Address - Street 2:
Practice Address - City:MCCHORD AFB
Practice Address - State:WA
Practice Address - Zip Code:98438-1303
Practice Address - Country:US
Practice Address - Phone:253-982-5505
Practice Address - Fax:253-982-3749
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11,1051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice