Provider Demographics
NPI:1336444793
Name:PINA-AWOSIKA, LISA Y (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:Y
Last Name:PINA-AWOSIKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6515 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-3101
Mailing Address - Country:US
Mailing Address - Phone:219-762-7080
Mailing Address - Fax:219-763-4012
Practice Address - Street 1:6515 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3101
Practice Address - Country:US
Practice Address - Phone:219-762-7080
Practice Address - Fax:219-763-4012
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011574A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice