Provider Demographics
NPI:1376755546
Name:LISBET CHERNIAVSKY, DDS PLLC
Entity Type:Organization
Organization Name:LISBET CHERNIAVSKY, DDS PLLC
Other - Org Name:BLUE RIDGE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-264-3333
Mailing Address - Street 1:PO BOX 1038
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-1038
Mailing Address - Country:US
Mailing Address - Phone:828-264-3333
Mailing Address - Fax:828-264-6340
Practice Address - Street 1:870 STATE FARM RD STE 103A
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4862
Practice Address - Country:US
Practice Address - Phone:828-264-3333
Practice Address - Fax:828-264-6340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1046911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998295Medicaid