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NPI Code Detail

MEDICARE: LISA D. PATRICK, DDS, P.C.

MEDICARE: LISA D. PATRICK, DDS, P.C.
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
1122300000XDentist

General Provider Information

NPI Number : 1437456811
Entity Type Code : Organization
Provider Name (Legal Business Name) : LISA D. PATRICK, DDS, P.C.
Provider Business Mailing Address
First Line : 601 E NAYLOR MILL RD
Second Line : SUITE E
City : SALISBURY
State : MD
Zip : 21804-2256
Country : US
Telephone Number : 410-219-5858
Fax Number :
Provider Business Practice Location Address
First Line : 601 E NAYLOR MILL RD
Second Line : SUITE E
City : SALISBURY
State : MD
Zip : 21804-2256
Country : US
Telephone Number : 410-219-5858
Fax Number :
Authorized Official
Title or Position : OWNER
Name : LISA PATRICK
Credential : DDS
Telephone Number : 410-219-5858
Provider Enumeration Date : 02/19/2011
Last Update Date : 02/19/2011

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