Provider Demographics
NPI:1376945634
Name:LISA LENISKI, DDS, MSD, LLC
Entity Type:Organization
Organization Name:LISA LENISKI, DDS, MSD, LLC
Other - Org Name:MICHIGAN CITY PEDIATRIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LENISKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:219-879-4559
Mailing Address - Street 1:211 MEDICAL PLZ
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3364
Mailing Address - Country:US
Mailing Address - Phone:219-879-4559
Mailing Address - Fax:219-879-4559
Practice Address - Street 1:211 E. 4TH STREET
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3364
Practice Address - Country:US
Practice Address - Phone:219-879-4559
Practice Address - Fax:219-879-4559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010935A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty