Provider Demographics
NPI:1184760365
Name:KNOWLES, LISA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNN
Last Name:KNOWLES
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 1:2024 LANSING RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8419
Mailing Address - Country:US
Mailing Address - Phone:517-543-5230
Mailing Address - Fax:517-543-5011
Practice Address - Street 1:2024 LANSING RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-8419
Practice Address - Country:US
Practice Address - Phone:517-543-5230
Practice Address - Fax:517-543-5011
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17386122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist