Provider Demographics
NPI:1568152213
Name:KILGORE, LILLIAN
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:KILGORE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:AL
Mailing Address - Zip Code:35094-2146
Mailing Address - Country:US
Mailing Address - Phone:205-699-2731
Mailing Address - Fax:
Practice Address - Street 1:1209 6TH ST
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:AL
Practice Address - Zip Code:35094-2146
Practice Address - Country:US
Practice Address - Phone:205-669-2731
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007209-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist