Provider Demographics
NPI:1063533685
Name:COLLINS, LISA RENEE (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:RENEE
Last Name:COLLINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 RUTLEDGE AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8681
Mailing Address - Country:US
Mailing Address - Phone:859-559-8511
Mailing Address - Fax:
Practice Address - Street 1:2212 RUTLEDGE AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-8681
Practice Address - Country:US
Practice Address - Phone:859-559-8511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6681122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist