Provider Demographics
NPI:1982979506
Name:VAN EYNDHOVEN, LISA HENRIKA (DDS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:HENRIKA
Last Name:VAN EYNDHOVEN
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 1:103 CHESAPEAKE BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6391
Mailing Address - Country:US
Mailing Address - Phone:410-648-2211
Mailing Address - Fax:
Practice Address - Street 1:103 CHESAPEAKE BLVD STE E
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6391
Practice Address - Country:US
Practice Address - Phone:410-648-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156601223P0221X
NJ22DI025583001223P0221X
NY86831361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry