Individual
LISA JANE TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
29 STONERIDGE DR, SUITE 103, WAYNESBORO, VA 22980-6598
(540) 943-0973
(540) 943-0974
Mailing address
29 STONERIDGE DRIVE, SUITE 103, WAYNESBORO, VA 22980
(540) 943-0973
(540) 943-0974
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401007656
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209599
ANTHEM
—
01
—
985885
UNITED CONCORDIA
—
Enumeration date
10/12/2006
Last updated
07/08/2007
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