Provider Demographics
NPI:1659199891
Name:LILAC KIDS PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:LILAC KIDS PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:CREEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-884-5076
Mailing Address - Street 1:215 RICHARDS AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5237
Mailing Address - Country:US
Mailing Address - Phone:978-884-5076
Mailing Address - Fax:
Practice Address - Street 1:5 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4807
Practice Address - Country:US
Practice Address - Phone:603-773-4900
Practice Address - Fax:603-775-7648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty