Healthcare Provider Details

I. General information

NPI: 1255996823
Provider Name (Legal Business Name): DR. LISA HORSCHMAN D.D.S., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2019
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19365 7TH AVE NE STE 106
POULSBO WA
98370-7441
US

IV. Provider business mailing address

19365 7TH AVE NE STE 106
POULSBO WA
98370-7441
US

V. Phone/Fax

Practice location:
  • Phone: 360-697-5818
  • Fax:
Mailing address:
  • Phone: 360-697-5818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1861747107
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerNPI

VIII. Authorized Official

Name: DR. LISA HORSCHMAN
Title or Position: OWNER
Credential: DDS
Phone: 360-697-5818