Healthcare Provider Details

I. General information

NPI: 1952308017
Provider Name (Legal Business Name): LISA A ADAMS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 SW CENTURY DR SUITE 102
BEND OR
97702-1657
US

IV. Provider business mailing address

155 SW CENTURY DR SUITE 102
BEND OR
97702-1657
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-7708
  • Fax:
Mailing address:
  • Phone: 541-382-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7826
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: