Individual
LISEANE KOGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2124 FORSYTHE AVE, MONROE, LA 71201-3611
(318) 388-4209
Mailing address
2124 FORSYTHE AVE, MONROE, LA 71201-3611
(318) 388-4209
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
36928
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
LA7286
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36928
TSBDE
TX
01
—
LA7286
LA
LA
Enumeration date
02/10/2021
Last updated
04/18/2022
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