Provider Demographics
NPI:1598836983
Name:NEAL, LISA MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:NEAL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:NEAL SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:132 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422
Mailing Address - Country:US
Mailing Address - Phone:859-236-2488
Mailing Address - Fax:859-236-1647
Practice Address - Street 1:132 N 2ND ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422
Practice Address - Country:US
Practice Address - Phone:859-236-2488
Practice Address - Fax:859-236-1647
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60070265Medicaid