Provider Demographics
NPI:1083839823
Name:MAYEDA, LISA AKEMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:AKEMI
Last Name:MAYEDA
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 1:620 KESWICK CT
Mailing Address - Street 2:
Mailing Address - City:GRANITE BAY
Mailing Address - State:CA
Mailing Address - Zip Code:95746-7156
Mailing Address - Country:US
Mailing Address - Phone:916-797-4875
Mailing Address - Fax:
Practice Address - Street 1:8920 SUNSET AVE STE A
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-6592
Practice Address - Country:US
Practice Address - Phone:916-535-0061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42936122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist