Provider Demographics
NPI:1477654556
Name:WORTHLEY, LISA LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNN
Last Name:WORTHLEY
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 1:2018 STEWARD LN
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-6501
Mailing Address - Country:US
Mailing Address - Phone:815-609-2594
Mailing Address - Fax:
Practice Address - Street 1:2241 THEODORE ST
Practice Address - Street 2:
Practice Address - City:CREST HILL
Practice Address - State:IL
Practice Address - Zip Code:60435-1881
Practice Address - Country:US
Practice Address - Phone:815-741-1700
Practice Address - Fax:815-741-8511
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice