Healthcare Provider Details

I. General information

NPI: 1013770841
Provider Name (Legal Business Name): LISA ANN LANHAM DD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 KING ST
BELLINGHAM WA
98229-6223
US

IV. Provider business mailing address

1329 KING ST
BELLINGHAM WA
98229-6223
US

V. Phone/Fax

Practice location:
  • Phone: 360-647-0395
  • Fax: 360-594-4387
Mailing address:
  • Phone: 360-647-0395
  • Fax: 360-594-4387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDN60938407
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: