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General NPI Number Information
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NPI Number | 1881494631
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Entity Type | Organization
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Legal Business Name | LILLEY GHARAVI DMD INC
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Dates
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Enumeration Date | 03/19/2025
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 28281 CROWN VALLEY PKWY STE 140
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-1483
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Country | US
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Telephone | 949-415-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 32039 CORTE CARDOZA
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City | TEMECULA
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State | CA
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Zip | 92592-3971
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Country | US
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Telephone | 909-996-0860
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. LILLEY GHARAVI
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Credential | DMD
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Telephone | 909-996-0860
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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