Healthcare Provider Details

I. General information

NPI: 1396756201
Provider Name (Legal Business Name): LISA A STAHLECKER DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 N BROAD ST
COLMAR PA
18915-9701
US

IV. Provider business mailing address

2410 N BROAD ST
COLMAR PA
18915-9701
US

V. Phone/Fax

Practice location:
  • Phone: 215-822-7070
  • Fax: 215-997-8290
Mailing address:
  • Phone: 215-822-7070
  • Fax: 215-997-8290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS027426L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: