Provider Demographics
NPI:1518540285
Name:RAWLE, LISA ANN (BDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:RAWLE
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:UIC PEDIATRIC DENTISTRY RESIDENCY RM 256D (MC 850)
Mailing Address - Street 2:801 S. PAULINA ST.
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613
Mailing Address - Country:US
Mailing Address - Phone:866-600-2273
Mailing Address - Fax:
Practice Address - Street 1:UIC PEDIATRIC DENTISTRY RESIDENCY RM 256D (MC 850)
Practice Address - Street 2:801 S. PAULINA ST.
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613
Practice Address - Country:US
Practice Address - Phone:312-413-7714
Practice Address - Fax:312-996-1981
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program