Provider Demographics
NPI:1710142567
Name:SWANSON, LISA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:SUSAN
Last Name:SWANSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-9543
Mailing Address - Country:US
Mailing Address - Phone:419-884-3411
Mailing Address - Fax:419-884-0656
Practice Address - Street 1:54 WESTERVIEW DR
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2682
Practice Address - Country:US
Practice Address - Phone:614-794-3629
Practice Address - Fax:614-794-3672
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH228551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice