Individual
LISA AUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD, MSD
Contact information
Practice address
1245 SE 3RD ST STE A1, BEND, OR 97702-2162
(541) 318-5688
Mailing address
1245 SE 3RD ST STE A1, BEND, OR 97702-2162
(541) 318-5688
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
10079
CO
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
D8548
OR
Other
Enumeration date
12/13/2006
Last updated
12/06/2022
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