Provider Demographics
NPI:1720381338
Name:KLIMOWSKI, LISA C (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:C
Last Name:KLIMOWSKI
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 1:22615 BUCKTROUT LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5118
Mailing Address - Country:US
Mailing Address - Phone:713-503-7371
Mailing Address - Fax:
Practice Address - Street 1:22615 BUCKTROUT LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5118
Practice Address - Country:US
Practice Address - Phone:713-503-7371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-21
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261911223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice