Provider Demographics
NPI:1013960616
Name:POAG, LISBETH W (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISBETH
Middle Name:W
Last Name:POAG
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 1:500 PHYSICIANS LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-3370
Mailing Address - Country:US
Mailing Address - Phone:803-775-4793
Mailing Address - Fax:803-934-9943
Practice Address - Street 1:500 PHYSICIANS LN
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3370
Practice Address - Country:US
Practice Address - Phone:803-775-4793
Practice Address - Fax:803-934-9943
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3503-0509PD1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ35034Medicaid