Provider Demographics
NPI:1699741413
Name:FARIS, LISA M (DMD MS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:FARIS
Suffix:
Gender:F
Credentials:DMD MS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:870 CLEVELAND ST
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-4427
Mailing Address - Country:US
Mailing Address - Phone:864-282-8555
Mailing Address - Fax:864-282-8551
Practice Address - Street 1:870 CLEVELAND ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-4427
Practice Address - Country:US
Practice Address - Phone:864-282-8555
Practice Address - Fax:864-282-8551
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC36831223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics