Provider Demographics
NPI:1245610849
Name:RISK, LIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIA
Middle Name:
Last Name:RISK
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 1:914 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORMANGEE
Mailing Address - State:TX
Mailing Address - Zip Code:77871-3456
Mailing Address - Country:US
Mailing Address - Phone:936-396-6510
Mailing Address - Fax:936-396-5555
Practice Address - Street 1:914 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NORMANGEE
Practice Address - State:TX
Practice Address - Zip Code:77871
Practice Address - Country:US
Practice Address - Phone:936-396-6510
Practice Address - Fax:936-396-5555
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350531223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty