MEDICARE: DR. CLIFFORD G LISMAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DI010843	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114014982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLIFFORD G LISMAN DMD

Provider Business Mailing Address
First Line	:	320 SOUTH MAIN STREET
Second Line	:	2ND FLR
City	:	PHILLIPSBURG
State	:	NJ
Zip	:	08865
Country	:	US
Telephone Number	:	908-387-6120
Fax Number	:	908-387-8322

Provider Business Practice Location Address
First Line	:	320 SOUTH MAIN STREET
Second Line	:
City	:	PHILLIPSBURG
State	:	NJ
Zip	:	08865-2824
Country	:	US
Telephone Number	:	908-387-6120
Fax Number	:	908-387-8322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/27/2014

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