Provider Demographics
NPI:1306592324
Name:RIDLEY, LISA KAREN (RDH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAREN
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 257TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5705
Mailing Address - Country:US
Mailing Address - Phone:206-819-5067
Mailing Address - Fax:
Practice Address - Street 1:3727 257TH AVE SE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98029-5705
Practice Address - Country:US
Practice Address - Phone:206-819-5067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-28
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00004028124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist