Provider Demographics
NPI:1275824732
Name:SHOFF, LISA J (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:SHOFF
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 MERCANTILE DR E STE 201
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7657
Mailing Address - Country:US
Mailing Address - Phone:240-651-5478
Mailing Address - Fax:
Practice Address - Street 1:6550 MERCANTILE DR E STE 201
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7657
Practice Address - Country:US
Practice Address - Phone:240-651-5478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037646122300000X
NC109381223P0300X
MD171751223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist