Individual
LISA ALLEN MASSEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDA
Contact information
Practice address
1205 RENAISSANCE PKWY STE 240, RIALTO, CA 92376-2418
(714) 942-4161
Mailing address
1205 RENAISSANCE PKWY STE 240, RIALTO, CA 92376-2418
(714) 942-4161
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
73043
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
73043
REGISTERED DENTAL ASSISTANT
CA
Enumeration date
05/20/2021
Last updated
05/20/2021
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