Provider Demographics
NPI:1568820710
Name:RITTER-KAHN, LISA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:RITTER-KAHN
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 1:800 WOODBURY ROAD
Mailing Address - Street 2:E
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797
Mailing Address - Country:US
Mailing Address - Phone:516-921-0400
Mailing Address - Fax:516-921-8629
Practice Address - Street 1:800 WOODBURY RD
Practice Address - Street 2:E
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2503
Practice Address - Country:US
Practice Address - Phone:516-921-0400
Practice Address - Fax:516-921-8629
Is Sole Proprietor?:No
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039520-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry