MEDICARE: LILY ROSE MLYNARCZYK

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	0401419466	VA

General Provider Information

NPI Number	:	1780474882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILY ROSE MLYNARCZYK

Provider Business Mailing Address
First Line	:	1670 HUGUENOT RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-2427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1670 HUGUENOT RD
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-2427
Country	:	US
Telephone Number	:	804-794-4564
Fax Number	:

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

Provider Enumeration Date	:	05/12/2025
Last Update Date	:	03/20/2026

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