MEDICARE: LILLIAN H JAIME D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DD1865	NM

General Provider Information

NPI Number	:	1558313882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN H JAIME D.M.D.

Provider Business Mailing Address
First Line	:	SIERRA DENTAL
Second Line	:	10411 LAGRIMA DE ORO NE
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3872
Country	:	US
Telephone Number	:	505-298-6724
Fax Number	:

Provider Business Practice Location Address
First Line	:	SIERRA DENTAL
Second Line	:	10411 LAGRIMA DE ORO NE
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111
Country	:	US
Telephone Number	:	505-298-6724
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	07/08/2007

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