Individual
LISA M DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
117 S MAIN RD, MOUNTAIN TOP, PA 18707-1903
(570) 474-9960
Mailing address
117 S MAIN RD, MOUNTAIN TOP, PA 18707-1903
(570) 474-9960
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS027372L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
633974
UNITED CONCORDIA PROVIDER
PA
Enumeration date
07/19/2006
Last updated
07/08/2007
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