Healthcare Provider Details

I. General information

NPI: 1407556848
Provider Name (Legal Business Name): LILY SULEMA LEMUS MARTINEZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14115 CULEBRA RD
SAN ANTONIO TX
78253-7756
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-807-7848
  • Fax:
Mailing address:
  • Phone: 210-450-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40453
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: