Provider Demographics
NPI:1477589232
Name:NOWLIN, LISA A (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:NOWLIN
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 1:201 GARRETT ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-4332
Mailing Address - Country:US
Mailing Address - Phone:580-225-4690
Mailing Address - Fax:580-225-8205
Practice Address - Street 1:201 GARRETT ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-4332
Practice Address - Country:US
Practice Address - Phone:580-225-4690
Practice Address - Fax:580-225-8205
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice