Provider Demographics
NPI:1306068838
Name:LISA JO ADORNETTO
Entity type:Organization
Organization Name:LISA JO ADORNETTO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ADORNETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-288-9878
Mailing Address - Street 1:3861 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9438
Mailing Address - Country:US
Mailing Address - Phone:336-855-7182
Mailing Address - Fax:
Practice Address - Street 1:3861 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9438
Practice Address - Country:US
Practice Address - Phone:336-855-7182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1548274269OtherNPI TYPE 1