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General NPI Number Information
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NPI Number | 1003763905
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Entity Type | Organization
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Legal Business Name | MATTHEW LISENBY DMD PC
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Dates
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Enumeration Date | 03/11/2026
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 7520 LONGLEY LN STE 104
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City | RENO
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State | NV
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Zip | 89511-9811
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Country | US
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Telephone | 775-409-4282
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Fax |
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Provider Business Mailing Address
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Address Line | 2049 AMBERWOOD DR
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City | CARSON CITY
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State | NV
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Zip | 89703-8413
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MATTHEW ROSS LISENBY
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Credential | DMD
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Telephone | 775-335-6763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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