Carter James Lilly, DDS
Individual provider Active NPI Dentist · West Milwaukee, WI
NPI 1962233890 · NPPES record last updated Aug 12, 2024
Key facts
- NPI
- 1962233890
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6001653-15 (WI)
- Practice address
- 2100 Miller Park Way
West Milwaukee, WI 53219-1641 - Phone
- (414) 645-4540
- NPI assigned
- Aug 12, 2024
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001653-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dental Associates LTD of Wisconsin | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6001653-15 | WI | Yes |
Addresses
Primary practice location
2100 Miller Park Way
West Milwaukee, WI 53219-1641
Mailing address
8428 W Becher St
West Allis, WI 53227-1722
Phone (712) 560-2802
Other providers in West Milwaukee, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.