Provider Demographics
NPI:1457453581
Name:PHILIP A LISK, DDS, PA
Entity Type:Organization
Organization Name:PHILIP A LISK, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LISK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-870-6892
Mailing Address - Street 1:901 PAVERSTONE DR
Mailing Address - Street 2:A
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4710
Mailing Address - Country:US
Mailing Address - Phone:919-870-6892
Mailing Address - Fax:919-870-1746
Practice Address - Street 1:901 PAVERSTONE DR
Practice Address - Street 2:A
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-4710
Practice Address - Country:US
Practice Address - Phone:919-870-6892
Practice Address - Fax:919-870-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty