Provider Demographics
NPI:1538505110
Name:ROMNEY, LISA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:ROMNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3632 W SOUTH JORDAN PKWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-7162
Mailing Address - Country:US
Mailing Address - Phone:801-446-4668
Mailing Address - Fax:
Practice Address - Street 1:3632 W SOUTH JORDAN PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-7162
Practice Address - Country:US
Practice Address - Phone:801-446-4668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7588071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice