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General NPI Number Information
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NPI Number | 1669776464
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Entity Type | Individual
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Provider Name | NISHA LIZ JOHN DDS
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Gender | Female
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Dates
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Enumeration Date | 01/07/2011
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 1900 EAST PIONEER PARKWAY
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City | ARLINGTON
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State | TX
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Zip | 76010
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Country | US
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Telephone | 803-446-2831
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Fax |
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Provider Business Mailing Address
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Address Line | 12040 ASHAWAY LANE
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City | FRISCO
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State | TX
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Zip | 75035-3038
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Country | US
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Telephone | 803-446-2831
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Fax | 719-583-1801
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN10271
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License Number State | CO
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