Healthcare Provider Details

I. General information

NPI: 1619425337
Provider Name (Legal Business Name): JAMES E. LILLENBERG DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 SOUTH LINDBENGH SUITE 108
SUNSET HILLS MO
63127
US

IV. Provider business mailing address

112 LADLIE GROVE LANE
CREVE COEUR MO
63141-7469
US

V. Phone/Fax

Practice location:
  • Phone: 314-244-3819
  • Fax: 314-842-0259
Mailing address:
  • Phone: 314-570-2072
  • Fax: 314-842-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number012959
License Number StateMO

VIII. Authorized Official

Name: JAMES E LILLENBERG
Title or Position: OFFICER
Credential: DDS
Phone: 314-570-2072