Provider Demographics
NPI:1710119672
Name:DR. LISA A GOIN, DDS, PC
Entity Type:Organization
Organization Name:DR. LISA A GOIN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GOIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:816-232-3011
Mailing Address - Street 1:805 N 36TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2979
Mailing Address - Country:US
Mailing Address - Phone:816-232-3011
Mailing Address - Fax:816-671-0205
Practice Address - Street 1:805 N 36TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2979
Practice Address - Country:US
Practice Address - Phone:816-232-3011
Practice Address - Fax:816-671-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty