Provider Demographics
NPI:1093849424
Name:LENISKI, LISA MARIE (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:LENISKI
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 1:211 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3364
Mailing Address - Country:US
Mailing Address - Phone:219-879-4559
Mailing Address - Fax:219-879-4559
Practice Address - Street 1:211 E 4TH ST
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3364
Practice Address - Country:US
Practice Address - Phone:219-879-4559
Practice Address - Fax:219-879-4559
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010935A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201036320Medicaid