Provider Demographics
NPI:1710040340
Name:FONAS, LISA G (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:G
Last Name:FONAS
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 1:1900 ARDMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15221-4602
Mailing Address - Country:US
Mailing Address - Phone:412-371-7100
Mailing Address - Fax:412-243-8142
Practice Address - Street 1:1900 ARDMORE BLVD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15221-4602
Practice Address - Country:US
Practice Address - Phone:412-371-7100
Practice Address - Fax:412-243-8142
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030795 L122300000X
FLDN15554122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001758003Medicaid