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General NPI Number Information
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NPI Number | 1003307703
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Entity Type | Organization
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Legal Business Name | LISA R. GAITHER DMD P.A.
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Dates
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Enumeration Date | 05/29/2018
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 1027 HANES MALL BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1310
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Country | US
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Telephone | 828-697-2826
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Fax |
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Provider Business Mailing Address
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Address Line | 1027 HANES MALL BLVD
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City | WINSTON SALEM
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State | NC
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Zip | 27103-1310
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Country | US
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Telephone | 828-697-2826
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | LISA GAITHER
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Credential | DMD
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Telephone | 828-697-2826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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