Provider Demographics
NPI:1538310610
Name:LAVINDER, LISA CRICKENBERGER (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CRICKENBERGER
Last Name:LAVINDER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:CRICKENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1621
Mailing Address - Country:US
Mailing Address - Phone:540-989-1170
Mailing Address - Fax:
Practice Address - Street 1:1930 ELECTRIC RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-1621
Practice Address - Country:US
Practice Address - Phone:540-989-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411623122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist