Healthcare Provider Details

I. General information

NPI: 1578002291
Provider Name (Legal Business Name): LILA KAKAR D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7210 DAY CREEK BLVD STE 110
RANCHO CUCAMONGA CA
91739-7543
US

IV. Provider business mailing address

6956 MALLOW DR UNIT 4
FONTANA CA
92336-2987
US

V. Phone/Fax

Practice location:
  • Phone: 909-803-1111
  • Fax:
Mailing address:
  • Phone: 516-806-7721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number103144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: