Provider Demographics
NPI:1013617497
Name:ALISHOUSE, LISA MARIE (RDH)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:ALISHOUSE
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 1:210 NW BARSTOW ST STE 305
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-3771
Mailing Address - Country:US
Mailing Address - Phone:262-953-4693
Mailing Address - Fax:262-522-2828
Practice Address - Street 1:N81W15062 APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3839
Practice Address - Country:US
Practice Address - Phone:262-522-7645
Practice Address - Fax:262-522-2828
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7001084-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist