Provider Demographics
NPI:1013908987
Name:SMARTZ, LISA J (DMD PA)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:SMARTZ
Suffix:
Gender:F
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:HOHOKUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07423
Mailing Address - Country:US
Mailing Address - Phone:201-652-1154
Mailing Address - Fax:201-652-0442
Practice Address - Street 1:110 WARREN AVE
Practice Address - Street 2:
Practice Address - City:HOHOKUS
Practice Address - State:NJ
Practice Address - Zip Code:07423
Practice Address - Country:US
Practice Address - Phone:201-652-1154
Practice Address - Fax:201-652-0442
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027545L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E53133Medicare UPIN
33576636Medicare ID - Type UnspecifiedNON PAR