Provider Demographics
NPI:1861587479
Name:GERMAIN, LISA PAM (DDS, MSCD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:PAM
Last Name:GERMAIN
Suffix:
Gender:F
Credentials:DDS, MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 NAPOLEON AVENUE
Mailing Address - Street 2:SUITE #701
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-7416
Mailing Address - Country:US
Mailing Address - Phone:504-895-1100
Mailing Address - Fax:504-895-1177
Practice Address - Street 1:2633 NAPOLEON AVENUE
Practice Address - Street 2:SUITE #701
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-7416
Practice Address - Country:US
Practice Address - Phone:504-895-1100
Practice Address - Fax:504-895-1177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics