Provider Demographics
NPI:1346465002
Name:POND, LIZA H (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:H
Last Name:POND
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4966 ASHWYCK PL
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1902
Mailing Address - Country:US
Mailing Address - Phone:937-298-5178
Mailing Address - Fax:
Practice Address - Street 1:714 S DIXIE DR
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2540
Practice Address - Country:US
Practice Address - Phone:937-890-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics