| NPI | 1073391728 |
|---|---|
| Doing Business As | LILAC DENTAL |
| Entity Type | Organization |
| Authorized Contact | SUMAN KISHORE KONDRAGUNTA Managing Member 347-631-0848 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2023-09-14 |
| Last Update Date | 2023-09-14 |