Provider Demographics
NPI:1770505521
Name:KANE, LISA (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KANE
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 1:6177 ORCHARD LAKE RD STE 120
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-2389
Mailing Address - Country:US
Mailing Address - Phone:248-855-6655
Mailing Address - Fax:248-855-0803
Practice Address - Street 1:6177 ORCHARD LAKE RD STE 120
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-2389
Practice Address - Country:US
Practice Address - Phone:248-855-6655
Practice Address - Fax:248-855-0803
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010182021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice