Provider Demographics
NPI:1821282591
Name:GIARRUSSO, LISA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:GIARRUSSO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27-29 MECHANIC ST
Mailing Address - Street 2:SUITE 230 MECHANICS PLACE
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-2414
Mailing Address - Country:US
Mailing Address - Phone:508-753-2489
Mailing Address - Fax:508-795-3892
Practice Address - Street 1:27-29 MECHANIC ST
Practice Address - Street 2:SUITE 230 MECHANICS PLACE
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-2414
Practice Address - Country:US
Practice Address - Phone:508-753-2489
Practice Address - Fax:508-795-3892
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics