Provider Demographics
NPI:1073603254
Name:DUBOS, LISA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:DUBOS
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 1:1200 LANCASTER PIKE
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113
Mailing Address - Country:US
Mailing Address - Phone:740-474-1900
Mailing Address - Fax:740-474-3991
Practice Address - Street 1:1200 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113
Practice Address - Country:US
Practice Address - Phone:740-474-1900
Practice Address - Fax:740-474-3991
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
89198Medicare UPIN
OH2215276Medicaid