Provider Demographics
NPI:1790948750
Name:LISING, JANICE IAN (DDS)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:IAN
Last Name:LISING
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 1:6018 BLACKBERRY COVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7368
Mailing Address - Country:US
Mailing Address - Phone:713-540-5616
Mailing Address - Fax:
Practice Address - Street 1:6300 W LOOP SOUTH #650
Practice Address - Street 2:SOUTH TEXAS DENTAL
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401
Practice Address - Country:US
Practice Address - Phone:713-663-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice