Provider Demographics
NPI:1992530356
Name:WATSON, LISA L (RDH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:PERKINSVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05151-9608
Mailing Address - Country:US
Mailing Address - Phone:802-376-4274
Mailing Address - Fax:
Practice Address - Street 1:55 VT ROUTE 11 W
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VT
Practice Address - Zip Code:05143-9202
Practice Address - Country:US
Practice Address - Phone:802-875-2878
Practice Address - Fax:802-875-6696
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT015.0001537124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist