MEDICARE: DR. LISA J SHOFF 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	122300000X	Dentist	DS037646	PA
2	1223P0300X	Periodontics	10938	NC
3	1223P0300X	Periodontics	17175	MD

General Provider Information

NPI Number	:	1275824732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA J SHOFF DMD

Provider Business Mailing Address
First Line	:	6550 MERCANTILE DR E STE 201
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-7657
Country	:	US
Telephone Number	:	240-651-5478
Fax Number	:

Provider Business Practice Location Address
First Line	:	6550 MERCANTILE DR E STE 201
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-7657
Country	:	US
Telephone Number	:	240-651-5478
Fax Number	:

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

Provider Enumeration Date	:	05/02/2011
Last Update Date	:	01/13/2020

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