Provider Demographics
NPI:1114014982
Name:LISMAN, CLIFFORD G (DMD)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:G
Last Name:LISMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:CLIFFORD
Other - Middle Name:G
Other - Last Name:LISMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:320 SOUTH MAIN STREET
Mailing Address - Street 2:2ND FLR
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-387-6120
Mailing Address - Fax:908-387-8322
Practice Address - Street 1:320 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-2824
Practice Address - Country:US
Practice Address - Phone:908-387-6120
Practice Address - Fax:908-387-8322
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0108431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1326708Medicaid