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NPI Code Detail

MEDICARE: LISA M VASSEUR DMD

MEDICARE: LISA M VASSEUR 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
11223G0001XGeneral Practice Dentistry7683KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17683OTHERKYKY LICENSE

General Provider Information

NPI Number : 1891794194
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M VASSEUR DMD
Provider Business Mailing Address
First Line : 215 E 11TH ST
Second Line :
City : NEWPORT
State : KY
Zip : 41071-2203
Country : US
Telephone Number : 859-655-6100
Fax Number :
Provider Business Practice Location Address
First Line : 1401 MADISON AVE
Second Line :
City : COVINGTON
State : KY
Zip : 41011-3313
Country : US
Telephone Number : 859-655-6100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2005
Last Update Date : 07/21/2021

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Directions to “ LISA M VASSEUR DMD” Practice Location

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