Provider Demographics
NPI:1275136137
Name:FLOUTON, LISA MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:FLOUTON
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 1:922 HARTFORD DR
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-2958
Mailing Address - Country:US
Mailing Address - Phone:386-628-1320
Mailing Address - Fax:
Practice Address - Street 1:237 E INTERNATIONAL SPEEDWAY BLVD STE B
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-2339
Practice Address - Country:US
Practice Address - Phone:386-943-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH19416124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist