Provider Demographics
NPI:1326316100
Name:LISA TRIPLETT-SHORT, DMD, PSC
Entity Type:Organization
Organization Name:LISA TRIPLETT-SHORT, DMD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:TRIPLETT-SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-785-0600
Mailing Address - Street 1:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:HINDMAN
Mailing Address - State:KY
Mailing Address - Zip Code:41822-1150
Mailing Address - Country:US
Mailing Address - Phone:606-785-0600
Mailing Address - Fax:606-785-0073
Practice Address - Street 1:1970 HIGHWAY 160 S
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822
Practice Address - Country:US
Practice Address - Phone:606-785-0600
Practice Address - Fax:606-785-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6526122300000X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty