Healthcare Provider Details

I. General information

NPI: 1669404299
Provider Name (Legal Business Name): LISA AMEER MARX DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA AMEER D.M.D.

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 12/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SOUTH STATE ROAD 7 SUITE 140
ROYAL PALM BEACH FL
33414
US

IV. Provider business mailing address

420 SOUTH STATE ROAD 7 SUITE 140
ROYAL PALM BEACH FL
33414
US

V. Phone/Fax

Practice location:
  • Phone: 561-798-4998
  • Fax: 561-798-4996
Mailing address:
  • Phone: 561-798-4998
  • Fax: 561-798-4996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 17119
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN17119
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: