Provider Demographics
NPI:1942513502
Name:CUMMINS, LISA KRISTINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:KRISTINE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BALA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-3213
Mailing Address - Country:US
Mailing Address - Phone:610-664-5644
Mailing Address - Fax:
Practice Address - Street 1:25 BALA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-3213
Practice Address - Country:US
Practice Address - Phone:610-664-5644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026346L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist