MEDICARE: LISA K. FROST DDS, LLC

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	1223G0001X	General Practice Dentistry	21364	OH

General Provider Information

NPI Number	:	1528047461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA K. FROST DDS, LLC

Provider Business Mailing Address
First Line	:	100 E 3RD ST
Second Line	:
City	:	WAVERLY
State	:	OH
Zip	:	45690-1401
Country	:	US
Telephone Number	:	740-947-8200
Fax Number	:	740-947-8210

Provider Business Practice Location Address
First Line	:	100 E 3RD ST
Second Line	:
City	:	WAVERLY
State	:	OH
Zip	:	45690-1401
Country	:	US
Telephone Number	:	740-947-8200
Fax Number	:	740-947-8210

Authorized Official
Title or Position	:	OWNER DENTIST
Name	:	DR. LISA K FROST
Credential	:	DDS
Telephone Number	:	740-947-8200

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/22/2020

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