Provider Demographics
NPI:1710191085
Name:PIONTEK, LISA RACHEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:RACHEL
Last Name:PIONTEK
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 1:2701 PARKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-1811
Mailing Address - Country:US
Mailing Address - Phone:920-499-1996
Mailing Address - Fax:
Practice Address - Street 1:526 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-4018
Practice Address - Country:US
Practice Address - Phone:920-448-7340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice