Provider Demographics
NPI:1215125281
Name:DIMEDIO, LIZA (DMD)
Entity type:Individual
Prefix:DR
First Name:LIZA
Middle Name:
Last Name:DIMEDIO
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 1:338 GEORGES RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1546
Mailing Address - Country:US
Mailing Address - Phone:732-329-3113
Mailing Address - Fax:
Practice Address - Street 1:338 GEORGES RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1546
Practice Address - Country:US
Practice Address - Phone:732-329-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDIO1286001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice