Provider Demographics
NPI:1316110067
Name:JAMES, LISA FEDOR (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:FEDOR
Last Name:JAMES
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:516 DELAWARE ST SE
Mailing Address - Street 2:7-300 PWB
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0356
Mailing Address - Country:US
Mailing Address - Phone:612-626-4232
Mailing Address - Fax:612-626-1972
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:7-300 PWB
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-626-4232
Practice Address - Fax:612-626-1972
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND115571223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics