Individual
DR. LISA MARIE MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1005 E LASALLE AVE, SOUTH BEND, IN 46617-2818
(574) 245-7501
(574) 245-7502
Mailing address
1005 E LASALLE AVE, SOUTH BEND, IN 46617-2818
(574) 245-7501
(574) 245-7502
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
12009706
IN
Other
Enumeration date
07/18/2006
Last updated
07/09/2007
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