Provider Demographics
NPI:1154445500
Name:ESMAILZADEH, LISA RENEE (RDH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:RENEE
Last Name:ESMAILZADEH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 STREAMWOOD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1937
Mailing Address - Country:US
Mailing Address - Phone:949-394-2281
Mailing Address - Fax:
Practice Address - Street 1:43 STREAMWOOD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1937
Practice Address - Country:US
Practice Address - Phone:949-394-2281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16975124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist