Healthcare Provider Details

I. General information

NPI: 1689655813
Provider Name (Legal Business Name): LILY ZHANG DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2005
Last Update Date: 01/28/2023
Certification Date: 01/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 HURLEY AVE SUITE 11
KINGSTON NY
12401-3739
US

IV. Provider business mailing address

40 HURLEY AVE SUITE 11
KINGSTON NY
12401-3739
US

V. Phone/Fax

Practice location:
  • Phone: 845-339-0964
  • Fax:
Mailing address:
  • Phone: 845-339-0964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number045352
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number045352
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: