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General NPI Number Information
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NPI Number | 1578239463
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Entity Type | Organization
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Legal Business Name | DR. PHIL LISK, DDS, PLLC
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Dates
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Enumeration Date | 08/19/2021
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Last Update Date | 03/21/2022
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Provider Practice Location Address
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Address Line | 3769 SUNSET AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3327
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Country | US
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Telephone | 252-443-0048
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Fax | 919-870-0702
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Provider Business Mailing Address
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Address Line | 3769 SUNSET AVE
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3327
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Country | US
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Telephone | 252-443-0048
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Fax | 919-870-0702
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PHILIP A LISK
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Credential | DDS
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Telephone | 919-637-0214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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