Provider Demographics
NPI:1083667026
Name:LEAR, LISA A (DDS MSD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:LEAR
Suffix:
Gender:F
Credentials:DDS MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6367 E TANQUE VERDE
Mailing Address - Street 2:#210
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715
Mailing Address - Country:US
Mailing Address - Phone:520-577-3935
Mailing Address - Fax:520-298-7112
Practice Address - Street 1:6367 E TANQUE VERDE
Practice Address - Street 2:#210
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715
Practice Address - Country:US
Practice Address - Phone:520-577-3935
Practice Address - Fax:520-298-7112
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist