Active NPI
Claire Kittaka Lilly, DMD
- Dentist
- Wayland, MI
National Provider Identifier
1265094460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 2901600222
- Practice address
- 899 Reno Dr
Wayland, MI 49348-1732 - Phone
- (269) 509-4155
- NPI assigned
- Jul 8, 2019
- Last updated
- Nov 29, 2021
- Sex
- Female
- 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 | 2901600222 | MI | Primary |
Addresses
Primary practice location
899 Reno Dr
Wayland, MI 49348-1732
Mailing address
201 Fulton St W Apt 1416
Grand Rapids, MI 49503-2678
Phone (317) 697-7702
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 |
|---|---|---|---|
| 2901600222 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1638144000000",
"number": "1265094460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 FULTON ST W APT 1416",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032678",
"telephone_number": "317-697-7702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "899 RENO DR",
"city": "WAYLAND",
"state": "MI",
"postal_code": "493481732",
"telephone_number": "269-509-4155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LILLY",
"first_name": "CLAIRE",
"middle_name": "KITTAKA",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-07-08",
"last_updated": "2021-11-29",
"certification_date": "2021-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "2901600222",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.