Provider Demographics
NPI:1922525260
Name:SWISHER, LISA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:SWISHER
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 1:142 SW MACKINAW WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32025-0480
Mailing Address - Country:US
Mailing Address - Phone:386-752-9914
Mailing Address - Fax:386-758-2180
Practice Address - Street 1:217 NE FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-2981
Practice Address - Country:US
Practice Address - Phone:386-752-9914
Practice Address - Fax:386-758-2180
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH11806124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist