Blackmon, Lisa Denise

Blackmon, Lisa Denise is an sole proprietor health care provider with primary practice located at 3729 Lee Road Shaker Heights Dental Express, Shaker Heights OH 44120. She recently has only one registered license in Dental Providers / Dentist, which is considered as her primary health care specialty. Blackmon, Lisa Denise can be contacted via phone (216) 751-9922.

Contact Information

Primary practice address
3729 Lee Road Shaker Heights Dental Express Shaker Heights OH 44120
Phone: (216) 751-9922
Fax: (216) 752-0870
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 20813 Ohio

Profile Details

NPI number 1235205527
LBN Legal business name Blackmon, Lisa Denise
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 28th, 2006
Last updated Oct 26th, 2009 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235205527 NPPES
Ohio MEDICAID 2066580

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