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General NPI Number Information
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NPI Number | 1881894376
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Entity Type | Individual
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Provider Name | LISA S KISPERT DDS
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Gender | Female
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Dates
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Enumeration Date | 07/23/2007
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 18803 SW BOONES FERRY RD STE 5
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City | TUALATIN
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State | OR
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Zip | 97062-8412
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Country | US
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Telephone | 36-923-7475
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Fax | 503-612-6948
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Provider Business Mailing Address
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Address Line | 3605 GRANT DR
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City | RENO
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State | NV
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Zip | 89509-5301
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Country | US
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Telephone | 775-409-4614
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Fax | 774-409-4614
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D9222
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00011251
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D9222
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License Number State | OR
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