Individual
TATYANA LYSENKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3201 ROUTE 38, SUITE 102, MOUNT LAUREL, NJ 08054-9721
(856) 722-0333
(856) 437-6101
Mailing address
3201 ROUTE 38, SUITE 102, MOUNT LAUREL, NJ 08054-9721
(856) 722-0333
(856) 437-6101
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
22DI01901700
NJ
Other
Enumeration date
03/14/2013
Last updated
09/28/2015
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