Provider Demographics
NPI:1972829158
Name:KLOSTERMAN, LISA K (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:K
Last Name:KLOSTERMAN
Suffix:
Gender:F
Credentials:DDS, MS
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 92633
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78709-2633
Mailing Address - Country:US
Mailing Address - Phone:512-206-6525
Mailing Address - Fax:
Practice Address - Street 1:1601 S LAMAR BLVD STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2924
Practice Address - Country:US
Practice Address - Phone:512-828-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA579321223X0400X
TX308561223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics