Provider Demographics
NPI:1457666463
Name:SIMPSON, LISA DODOBARA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:DODOBARA
Last Name:SIMPSON
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 1:33515 10TH PL S
Mailing Address - Street 2:BUILDING 12
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-7300
Mailing Address - Country:US
Mailing Address - Phone:253-838-9996
Mailing Address - Fax:
Practice Address - Street 1:33515 10TH PL S
Practice Address - Street 2:BUILDING 12
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-7300
Practice Address - Country:US
Practice Address - Phone:253-838-9996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60172418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist