Organization
LILLY FAMILY DENTISTRY, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN R. LILLY D.D.S. (OWNER)
(712) 239-5125
Entity
Organization
Contact information
Practice address
2100 INDIAN HILLS DR, SIOUX CITY, IA 51104-1604
(712) 239-5125
(712) 239-2275
Mailing address
2100 INDIAN HILLS DR, SIOUX CITY, IA 51104-1604
(712) 239-5125
(712) 239-2275
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7577
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1106369
—
IA
Enumeration date
11/02/2006
Last updated
08/22/2020
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