Provider Demographics
NPI:1306031224
Name:ABIS-VELASCO, LISA HOLLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:HOLLY
Last Name:ABIS-VELASCO
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 1:47 ROMAR AVE
Mailing Address - Street 2:BASEMENT
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1834
Mailing Address - Country:US
Mailing Address - Phone:201-985-8877
Mailing Address - Fax:201-433-8289
Practice Address - Street 1:47 ROMAR AVE
Practice Address - Street 2:BASEMENT
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1834
Practice Address - Country:US
Practice Address - Phone:201-985-8877
Practice Address - Fax:201-433-8289
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01832100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist