Provider Demographics
NPI:1073738969
Name:FERENCE, LISA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:FERENCE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:HAMMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:1111 CLIFTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-3633
Mailing Address - Country:US
Mailing Address - Phone:973-779-2819
Mailing Address - Fax:
Practice Address - Street 1:1111 CLIFTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-3633
Practice Address - Country:US
Practice Address - Phone:973-779-2819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0175491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice