Provider Demographics
NPI:1043929854
Name:VINSACK, LISA VIRGINIA (DH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:VIRGINIA
Last Name:VINSACK
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:VIRGINIA
Other - Last Name:OBERSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:799 FOREST ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-4117
Mailing Address - Country:US
Mailing Address - Phone:419-651-7011
Mailing Address - Fax:
Practice Address - Street 1:343 WARRIOR RD
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314
Practice Address - Country:US
Practice Address - Phone:912-435-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.008911124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist