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NPI Code Detail

MEDICARE: LISA RADER DMD

MEDICARE: LISA RADER DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDS023554PA

General Provider Information

NPI Number : 1184905317
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA RADER DMD
Provider Business Mailing Address
First Line : 532 S OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2615
Country : US
Telephone Number : 215-946-3655
Fax Number :
Provider Business Practice Location Address
First Line : 532 S OXFORD VALLEY RD
Second Line :
City : FAIRLESS HILLS
State : PA
Zip : 19030-2615
Country : US
Telephone Number : 215-946-3655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2011
Last Update Date : 09/01/2011

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Directions to “ LISA RADER DMD” Practice Location

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