Provider Demographics
NPI:1568501732
Name:SENTCHOUK, LILIA (LD)
Entity type:Individual
Prefix:
First Name:LILIA
Middle Name:
Last Name:SENTCHOUK
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10555 SE 82ND AVE
Mailing Address - Street 2:# 102
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97266-7374
Mailing Address - Country:US
Mailing Address - Phone:503-358-9098
Mailing Address - Fax:
Practice Address - Street 1:10555 SE 82ND AVE
Practice Address - Street 2:# 102
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97266-7374
Practice Address - Country:US
Practice Address - Phone:503-358-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-10115004122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist