Provider Demographics
NPI:1316395965
Name:MCGANN, LISA EILEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:EILEEN
Last Name:MCGANN
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 1:872 GOODRICH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3124
Mailing Address - Country:US
Mailing Address - Phone:651-231-3196
Mailing Address - Fax:
Practice Address - Street 1:757 CLEVELAND AVE S STE 2
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55116-1301
Practice Address - Country:US
Practice Address - Phone:651-699-1547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13661122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist