Individual
DR. LISA DEAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1592 DIEDERICH BLVD, RUSSELL, KY 41169-1676
(606) 836-9962
(606) 836-4668
Mailing address
1592 DIEDERICH BLVD, RUSSELL, KY 41169-1676
(606) 836-9962
(606) 836-4668
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401418621
VA
1223G0001X
General Practice Dentistry
6890
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2436288,9962
—
OH
05
—
60068905
—
KY
Enumeration date
12/21/2006
Last updated
06/06/2024
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