Provider Demographics
NPI:1215930201
Name:ELIAS, LISA (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ELIAS
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 1:443 PEARL RD
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-1115
Mailing Address - Country:US
Mailing Address - Phone:330-273-7300
Mailing Address - Fax:330-225-5060
Practice Address - Street 1:443 PEARL RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-1115
Practice Address - Country:US
Practice Address - Phone:330-273-7300
Practice Address - Fax:330-225-5060
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH191741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice