MEDICARE: DR. NATASHA ALEXIS LISIN-QUEEN 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	22194	MA
2	122300000X	Dentist	DN014359	GA

General Provider Information

NPI Number	:	1902068372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATASHA ALEXIS LISIN-QUEEN DMD

Provider Business Mailing Address
First Line	:	230 CHICKERING LAKE DR
Second Line	:
City	:	ROSWELL
State	:	GA
Zip	:	30075-3278
Country	:	US
Telephone Number	:	314-498-9006
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 DALLAS HWY SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-2567
Country	:	US
Telephone Number	:	407-462-9828
Fax Number	:

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

Provider Enumeration Date	:	06/27/2008
Last Update Date	:	01/05/2026

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