Active NPI
Christopher Lillenberg, DDS
- Dentist
- Altus AFB, OK
National Provider Identifier
1063075414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 35590
- Practice address
- 301 N 1St St
Altus AFB, OK 73523-5004 - Phone
- (580) 481-5262
- NPI assigned
- Apr 20, 2019
- Last updated
- Jul 27, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 35590 | TX | Primary |
Addresses
Primary practice location
301 N 1St St
Altus AFB, OK 73523-5004
Mailing address
301 N 1St St # 46
Altus, OK 73523-5004
Phone (580) 481-5081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35590 | TX | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1555718400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658880000000",
"number": "1063075414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 N 1ST ST # 46",
"city": "ALTUS",
"state": "OK",
"postal_code": "735235004",
"telephone_number": "580-481-5081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N 1ST ST",
"city": "ALTUS AFB",
"state": "OK",
"postal_code": "735235004",
"telephone_number": "580-481-5262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLENBERG",
"first_name": "CHRISTOPHER",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-20",
"last_updated": "2022-07-27",
"certification_date": "2021-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "35590",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Altus AFB, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.