Healthcare Provider Details

I. General information

NPI: 1508070640
Provider Name (Legal Business Name): LILLIAN MILLER DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 S INTERSTATE 35 E STE 210
DENTON TX
76205-4986
US

IV. Provider business mailing address

2430 S INTERSTATE 35 E STE 210
DENTON TX
76205-4986
US

V. Phone/Fax

Practice location:
  • Phone: 940-387-2214
  • Fax: 940-387-2212
Mailing address:
  • Phone: 940-387-2214
  • Fax: 940-387-2212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyX
Taxonomy Code122300000X
TaxonomyDentist
License Number20062
License Number StateTX
# 2
Primary TaxonomyX
Taxonomy Code122300000X
TaxonomyDentist
License Number22256
License Number StateTX
# 3
Primary TaxonomyX
Taxonomy Code122300000X
TaxonomyDentist
License Number22427
License Number StateTX
# 4
Primary TaxonomyX
Taxonomy Code122300000X
TaxonomyDentist
License Number21050
License Number StateTX
# 5
Primary TaxonomyX
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedic Dentist
License Number21456
License Number StateTX

VIII. Authorized Official

Name: DR. APRIL LORE KANEIRA
Title or Position: DENTAL DIRECTOR
Credential: DDS
Phone: 940-387-2214