Healthcare Provider Details

I. General information

NPI: 1699612069
Provider Name (Legal Business Name): LILIANA MARSHALL DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S BATTLEGROUND AVE
KINGS MOUNTAIN NC
28086-3401
US

IV. Provider business mailing address

125 S BATTLEGROUND AVE
KINGS MOUNTAIN NC
28086-3401
US

V. Phone/Fax

Practice location:
  • Phone: 321-505-7763
  • Fax:
Mailing address:
  • Phone: 321-505-7763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. WYATT HOOVER
Title or Position: PRACTICE MANAGER
Credential:
Phone: 321-505-7763