Provider Demographics
NPI:1457307068
Name:RANGEL, LISA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:RANGEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ELM ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-8102
Mailing Address - Country:US
Mailing Address - Phone:973-292-0001
Mailing Address - Fax:973-267-4949
Practice Address - Street 1:3 ELM ST
Practice Address - Street 2:SUITE 205
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8102
Practice Address - Country:US
Practice Address - Phone:973-292-0001
Practice Address - Fax:973-267-4949
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI021248122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist