Provider Demographics
NPI:1902940315
Name:LISA M FELDMAN DMD PA
Entity type:Organization
Organization Name:LISA M FELDMAN DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FELDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-737-3633
Mailing Address - Street 1:9804 S MILITARY TRL
Mailing Address - Street 2:SUITE E-3
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3208
Mailing Address - Country:US
Mailing Address - Phone:561-737-3633
Mailing Address - Fax:561-737-5194
Practice Address - Street 1:9804 S MILITARY TRL
Practice Address - Street 2:SUITE E-3
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3208
Practice Address - Country:US
Practice Address - Phone:561-737-3633
Practice Address - Fax:561-737-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-18
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN119701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty