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General NPI Number Information
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NPI Number | 1053940569
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Entity Type | Individual
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Provider Name | LISA MICHELLE CARRINGTON
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 150 N JACKSON AVE STE 110
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City | SAN JOSE
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State | CA
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Zip | 95116-1908
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Country | US
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Telephone | 925-817-7685
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Fax |
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Provider Business Mailing Address
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Address Line | 3282 VALS LN
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City | LAFAYETTE
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State | CA
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Zip | 94549-2611
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Country | US
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Telephone | 925-817-7685
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 105917
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License Number State | CA
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