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General NPI Number Information
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NPI Number | 1609933548
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Entity Type | Organization
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Legal Business Name | LISA VOURAS DMD PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 85 WOBURN ST
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City | READING
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State | MA
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Zip | 01867-2906
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Country | US
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Telephone | 781-944-4940
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Fax | 781-944-0445
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Provider Business Mailing Address
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Address Line | 85 WOBURN ST
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City | READING
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State | MA
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Zip | 01867-2906
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Country | US
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Telephone | 781-944-4940
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Fax | 781-944-0445
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LISA VOURAS
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Credential | DMD
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Telephone | 781-944-4940
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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 | 17775
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License Number State | MA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 17775
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Identifier Type | OTHER
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Identifier State | MA
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Identifier Issuer | DELTA DENTAL OF MASS.
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 17775
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Identifier Type | OTHER
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Identifier State | MA
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Identifier Issuer | DELTA DENTAL OF MASS.
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