Healthcare Provider Details

I. General information

NPI: 1952401788
Provider Name (Legal Business Name): LISA B VALINS DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 LAUREL MALL UNIT B
HAZLETON PA
18202-1205
US

IV. Provider business mailing address

4140 ROCHELLE DR
ALLENTOWN PA
18104-8900
US

V. Phone/Fax

Practice location:
  • Phone: 610-223-7777
  • Fax:
Mailing address:
  • Phone: 516-242-1661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number044600-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS045409
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: