Provider Demographics
NPI:1396736682
Name:YARBROUGH, LISA (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:MCCAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:US ARMY DENTAL ACTIVITY JBLM BLDG 9900 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4035
Mailing Address - Fax:
Practice Address - Street 1:US ARMY DENTAL ACTIVITY JBLM BLDG 9900 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15047122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist