Provider Demographics
NPI:1215683461
Name:TABASSIAN, LILIA JOY (DMD)
Entity type:Individual
Prefix:
First Name:LILIA
Middle Name:JOY
Last Name:TABASSIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3791 PALM VALLEY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4180
Mailing Address - Country:US
Mailing Address - Phone:904-834-2736
Mailing Address - Fax:
Practice Address - Street 1:3791 PALM VALLEY RD STE 205
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4180
Practice Address - Country:US
Practice Address - Phone:904-834-2736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-25
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26978122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist