Provider Demographics
NPI:1437464211
Name:HSU, LISA L (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:L
Last Name:HSU
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 1:2550 N WATTERS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6003
Mailing Address - Country:US
Mailing Address - Phone:972-649-7990
Mailing Address - Fax:972-649-7991
Practice Address - Street 1:2550 N WATTERS RD STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6003
Practice Address - Country:US
Practice Address - Phone:972-649-7990
Practice Address - Fax:972-649-7991
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02449000122300000X
TX26220122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist