Provider Demographics
NPI:1235248469
Name:RANDALL, LISBETH ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISBETH
Middle Name:ANN
Last Name:RANDALL
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 1:9931 ELLER RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038
Mailing Address - Country:US
Mailing Address - Phone:317-578-2533
Mailing Address - Fax:
Practice Address - Street 1:9931 ELLER RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038
Practice Address - Country:US
Practice Address - Phone:317-578-2533
Practice Address - Fax:317-578-2433
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009343122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist