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Organization
LILAC DENTAL PLLC
Active
Organization
LILAC DENTAL PLLC
Active
Other names
Lilac Dental
Organization subpart
No
Provider details
NPI number
Authorized official
SUMAN KISHORE KONDRAGUNTA DDS (MANAGING MEMBER)
(347) 631-0848
Entity
Organization
Contact information
Practice address
12314 N INTERSTATE 35 STE 110, AUSTIN, TX 78753-1349
(347) 631-0848
Mailing address
15412 CABRILLO WAY, AUSTIN, TX 78738-4128
(347) 631-0848
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
09/14/2023
Last updated
09/14/2023
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