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NPI Code Detail

MEDICARE: LISA MCGANN, DDS, PA

MEDICARE: LISA MCGANN, DDS, PA
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
1261QD0000XDental Clinic/Center

General Provider Information

NPI Number : 1144735234
Entity Type Code : Organization
Provider Name (Legal Business Name) : LISA MCGANN, DDS, PA
Provider Business Mailing Address
First Line : 757 CLEVELAND AVE S STE 2
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1301
Country : US
Telephone Number : 651-699-1547
Fax Number :
Provider Business Practice Location Address
First Line : 757 CLEVELAND AVE S STE 2
Second Line :
City : SAINT PAUL
State : MN
Zip : 55116-1301
Country : US
Telephone Number : 651-699-1547
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : DR. LISA MCGANN
Credential : DDS
Telephone Number : 651-231-3196
Provider Enumeration Date : 12/11/2017
Last Update Date : 06/16/2018

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Directions to “LISA MCGANN, DDS, PA ” Practice Location

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