Individual
DR. PHILIP ALAN LISK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
901 PAVERSTONE DR STE A, RALEIGH, NC 27615-4708
(919) 870-6892
(919) 870-1746
Mailing address
901 PAVERSTONE DR STE A, RALEIGH, NC 27615-4708
(919) 870-6892
(919) 870-1746
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6746
NC
261QM1300X
Multi-Specialty Clinic/Center
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8990041
—
NC
Enumeration date
12/19/2007
Last updated
09/29/2021
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