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General NPI Number Information
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NPI Number | 1902068372
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Entity Type | Individual
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Provider Name | NATASHA ALEXIS LISIN-QUEEN DMD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 2500 DALLAS HWY SW
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City | MARIETTA
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State | GA
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Zip | 30064-2567
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Country | US
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Telephone | 407-462-9828
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Fax |
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Provider Business Mailing Address
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Address Line | 230 CHICKERING LAKE DR
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City | ROSWELL
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State | GA
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Zip | 30075-3278
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Country | US
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Telephone | 314-498-9006
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 22194
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License Number State | MA
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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 | DN014359
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License Number State | GA
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