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General NPI Number Information
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NPI Number | 1649625518
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Entity Type | Individual
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Provider Name | LISA ATLAS CANDON DDS
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Gender | Female
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 10/10/2023
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Provider Practice Location Address
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Address Line | 2700 COLTSGATE RD STE 204
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City | CHARLOTTE
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State | NC
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Zip | 28211-3573
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Country | US
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Telephone | 704-749-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 16748 KRISHNA LN
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City | CHARLOTTE
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State | NC
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Zip | 28277-1638
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Country | US
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Telephone | 704-763-8188
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 10913
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30.024996
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License Number State | OH
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