MEDICARE: DR. LISA EILEEN MCGANN DDS

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
1	122300000X	Dentist	D13661	MN

General Provider Information

NPI Number	:	1316395965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA EILEEN MCGANN DDS

Provider Business Mailing Address
First Line	:	872 GOODRICH AVE
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55105-3124
Country	:	US
Telephone Number	:	651-231-3196
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 CLEVELAND AVE S STE 2
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55116-1301
Country	:	US
Telephone Number	:	651-699-1547
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2016
Last Update Date	:	07/10/2018

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