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NPI Code Detail

MEDICARE: DR. LISA MCGLONE D.D.S.

MEDICARE: DR. LISA MCGLONE D.D.S.
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 Dentistry19868TX

General Provider Information

NPI Number : 1962490151
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA MCGLONE D.D.S.
Provider Business Mailing Address
First Line : 1108 N MECHANIC ST
Second Line :
City : EL CAMPO
State : TX
Zip : 77437-3030
Country : US
Telephone Number : 979-541-5400
Fax Number :
Provider Business Practice Location Address
First Line : 1108 N MECHANIC ST
Second Line :
City : EL CAMPO
State : TX
Zip : 77437-3030
Country : US
Telephone Number : 979-541-5400
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 01/23/2017

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