Provider Demographics
NPI:1386893220
Name:SALISBURY, LISA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:SALISBURY
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:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IL
Mailing Address - Zip Code:60071-0532
Mailing Address - Country:US
Mailing Address - Phone:815-678-4551
Mailing Address - Fax:815-678-4555
Practice Address - Street 1:10015 MAIN STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IL
Practice Address - Zip Code:60071
Practice Address - Country:US
Practice Address - Phone:815-678-4551
Practice Address - Fax:815-678-4555
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019024483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist