Individual
DR. LISA GUSHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
203 OWEN DR, FAYETTEVILLE, NC 28304-3409
(910) 484-1771
Mailing address
203 OWEN DR, FAYETTEVILLE, NC 28304-3409
(910) 484-1771
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
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
11/16/2006
Last updated
01/24/2008
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