Provider Demographics
NPI:1598194839
Name:MORAVEC, LISA J (RDH, MS)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:MORAVEC
Suffix:
Gender:F
Credentials:RDH, MS
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:955 COUNTRY CLUB RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1754
Mailing Address - Country:US
Mailing Address - Phone:308-633-3368
Mailing Address - Fax:308-633-3371
Practice Address - Street 1:955 COUNTRY CLUB RD
Practice Address - Street 2:SUITE C
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1754
Practice Address - Country:US
Practice Address - Phone:308-633-3368
Practice Address - Fax:308-633-3371
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE1631124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist