Healthcare Provider Details

I. General information

NPI: 1235330150
Provider Name (Legal Business Name): LISA FROST STRUNK DDS MS MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2514 S 119TH ST
OMAHA NE
68144-2869
US

IV. Provider business mailing address

2514 S 119TH ST
OMAHA NE
68144-2869
US

V. Phone/Fax

Practice location:
  • Phone: 402-330-5913
  • Fax: 402-333-3190
Mailing address:
  • Phone: 402-330-5913
  • Fax: 402-333-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number5175
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: