Healthcare Provider Details

I. General information

NPI: 1629981543
Provider Name (Legal Business Name): LISA CANDON, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14722 LAWYERS RD
MATTHEWS NC
28104
US

IV. Provider business mailing address

212 PUMPKIN SEED CT
MATTHEWS NC
28104-0006
US

V. Phone/Fax

Practice location:
  • Phone: 704-322-4496
  • Fax: 704-322-4498
Mailing address:
  • Phone: 704-763-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: LISA CANDON
Title or Position: OWNER
Credential: DDS
Phone: 704-763-8188