Organization
LISA GUSHIN D.D.S. P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA GUSHIN D.D.S. (PRESIDENT)
(910) 484-1771
Entity
Organization
Contact information
Practice address
203 OWEN DR, FAYETTEVILLE, NC 28304-3409
(910) 484-1771
(910) 484-8876
Mailing address
203 OWEN DR, FAYETTEVILLE, NC 28304-3409
(910) 484-1771
(910) 484-8876
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
6908
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
586286
UNITED CONCORDIA
NC
05
—
899010F
—
NC
01
—
9010F
BCBS
NC
Enumeration date
01/29/2008
Last updated
01/29/2008
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