Provider Demographics
NPI:1659415065
Name:FELDMAN, LISA M (DMD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:FELDMAN
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 1:9804 S MILITARY TRL
Mailing Address - Street 2:STE E-3
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-3208
Mailing Address - Country:US
Mailing Address - Phone:561-737-3633
Mailing Address - Fax:561-737-5194
Practice Address - Street 1:9804 S MILITARY TRL
Practice Address - Street 2:STE E-3
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-3208
Practice Address - Country:US
Practice Address - Phone:561-737-3633
Practice Address - Fax:561-737-5194
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2015-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN119701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry