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General NPI Number Information
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NPI Number | 1699741413
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Entity Type | Individual
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Provider Name | LISA M FARIS D.M.D. M.S.
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Gender | Female
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 870 CLEVELAND ST SUITE 2C
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City | GREENVILLE
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State | SC
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Zip | 29601-4427
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Country | US
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Telephone | 864-282-8555
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Fax | 864-282-8551
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Provider Business Mailing Address
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Address Line | 870 CLEVELAND ST SUITE 2C
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City | GREENVILLE
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State | SC
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Zip | 29601-4427
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Country | US
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Telephone | 864-282-8555
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Fax | 864-282-8551
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 3683
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License Number State | SC
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