Organization
LISA M MA DMD, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA M MA DMD (MEMBER)
(305) 335-2252
Entity
Organization
Contact information
Practice address
5347 N SOCRUM LOOP RD, LAKELAND, FL 33809-4256
(863) 606-5721
Mailing address
5347 N SOCRUM LOOP RD, LAKELAND, FL 33809-4256
(863) 606-5721
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
07/02/2020
Last updated
08/17/2021
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