Provider Demographics
NPI:1760015820
Name:SOLTANI, LISA ANN (RDH)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SOLTANI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-9457
Mailing Address - Country:US
Mailing Address - Phone:775-287-1717
Mailing Address - Fax:
Practice Address - Street 1:1664 WEEKSVILLE RD BLDG 128
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6701
Practice Address - Country:US
Practice Address - Phone:252-335-6460
Practice Address - Fax:252-335-6255
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND12446124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist