Individual
LUCELY SANTILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1935 MEDICAL DISTRICT DR, DALLAS, TX 75235-7701
(214) 456-2735
Mailing address
4880 N PRESIDENT GEORGE BUSH HWY # 104, GARLAND, TX 75040-2742
(978) 635-2217
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
37665
TX
1223G0001X
General Practice Dentistry
37665
TX
1223P0221X
Pediatric Dentistry
Primary
37665
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/29/2021
Last updated
01/13/2026
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