Provider Demographics
NPI:1013139492
Name:RICHARDS, LISA ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANNE
Last Name:RICHARDS
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 1:4699 HAMANN PKWY
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-5631
Mailing Address - Country:US
Mailing Address - Phone:440-942-0860
Mailing Address - Fax:440-951-1246
Practice Address - Street 1:4699 HAMANN PKWY
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-5631
Practice Address - Country:US
Practice Address - Phone:440-942-0860
Practice Address - Fax:440-951-1246
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH187151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0699856Medicaid