Provider Demographics
NPI:1588899207
Name:TRILLIUM DENTAL PC
Entity type:Organization
Organization Name:TRILLIUM DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:VUILLEMOT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-485-3444
Mailing Address - Street 1:2524 LAKE LANSING RD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-3620
Mailing Address - Country:US
Mailing Address - Phone:517-485-3444
Mailing Address - Fax:517-485-3763
Practice Address - Street 1:2524 LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-3620
Practice Address - Country:US
Practice Address - Phone:517-485-3444
Practice Address - Fax:517-485-3763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14161, 141471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty