Provider Demographics
NPI:1205918786
Name:CONARD, LISA A (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:CONARD
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 1:1705 INDIANAPOLIS AVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2936
Mailing Address - Country:US
Mailing Address - Phone:765-428-1060
Mailing Address - Fax:765-482-1060
Practice Address - Street 1:1705 INDIANAPOLIS AVE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2936
Practice Address - Country:US
Practice Address - Phone:765-428-1060
Practice Address - Fax:765-482-1060
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120091851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice