MEDICARE: DR. TIMOTHY LYNN LILLARD DDS

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	1223G0001X	General Practice Dentistry	11,105	TX

General Provider Information

NPI Number	:	1952399677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY LYNN LILLARD DDS

Provider Business Mailing Address
First Line	:	17808 87TH AVE E
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98375-6244
Country	:	US
Telephone Number	:	253-875-4611
Fax Number	:

Provider Business Practice Location Address
First Line	:	690 BARNES BLVD
Second Line	:
City	:	MCCHORD AFB
State	:	WA
Zip	:	98438-1303
Country	:	US
Telephone Number	:	253-982-5505
Fax Number	:	253-982-3749

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	07/08/2007

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