Provider Demographics
NPI:1770686156
Name:BURKETT, LISA R (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:BURKETT
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Gender:F
Credentials:DDS MS
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Mailing Address - Street 1:6818 AUSTIN CENTER BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-458-1162
Mailing Address - Fax:512-458-1747
Practice Address - Street 1:6818 AUSTIN CENTER BLVD
Practice Address - Street 2:STE 203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-458-1162
Practice Address - Fax:512-458-1747
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX170611223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics