Provider Demographics
NPI:1073676417
Name:CHRISTY, LISA J (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:CHRISTY
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:PO BOX 748
Mailing Address - Street 2:9500 RED ARROW HIGHWAY
Mailing Address - City:BRIDGMAN
Mailing Address - State:MI
Mailing Address - Zip Code:49106-0748
Mailing Address - Country:US
Mailing Address - Phone:269-465-3001
Mailing Address - Fax:269-465-3001
Practice Address - Street 1:9500 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:BRIDGMAN
Practice Address - State:MI
Practice Address - Zip Code:49106-9593
Practice Address - Country:US
Practice Address - Phone:269-465-3001
Practice Address - Fax:269-465-3001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901018067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist