Provider Demographics
NPI:1720382948
Name:LISA A FAGIOLETTI DMD LLC
Entity Type:Organization
Organization Name:LISA A FAGIOLETTI DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:FAGIOLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-598-1982
Mailing Address - Street 1:25 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1463
Mailing Address - Country:US
Mailing Address - Phone:302-598-1982
Mailing Address - Fax:
Practice Address - Street 1:25 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1463
Practice Address - Country:US
Practice Address - Phone:302-598-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty