Individual
LISA LICHTIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
238 FRONT ST, CASHTON, WI 54619-2002
(608) 654-5100
Mailing address
509 LEE DR, WEST SALEM, WI 54669-1924
(608) 780-3013
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
5299-16
WI
Other
Enumeration date
08/22/2012
Last updated
08/22/2012
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