Provider Demographics
NPI:1710643192
Name:KAPNICK, LISA (FDN, RDH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KAPNICK
Suffix:
Gender:F
Credentials:FDN, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 CLUBHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3147
Mailing Address - Country:US
Mailing Address - Phone:914-403-0393
Mailing Address - Fax:914-478-1142
Practice Address - Street 1:19 CLUBHOUSE LN
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3147
Practice Address - Country:US
Practice Address - Phone:914-403-0393
Practice Address - Fax:914-478-1142
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017036-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist