Provider Demographics
NPI:1710006507
Name:AUGUSTINE, LISA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MICHELLE
Last Name:AUGUSTINE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MICHELLE
Other - Last Name:YAROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2900 S PEORIA ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5712
Mailing Address - Country:US
Mailing Address - Phone:303-751-3321
Mailing Address - Fax:
Practice Address - Street 1:2900 S PEORIA ST
Practice Address - Street 2:UNIT C
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5712
Practice Address - Country:US
Practice Address - Phone:303-751-3321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7439122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist