Provider Demographics
NPI:1356352181
Name:KLEMENZ, LISA GAYLE (DMD, MSD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:GAYLE
Last Name:KLEMENZ
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9120 HURSTBOURNE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1627
Mailing Address - Country:US
Mailing Address - Phone:502-491-3650
Mailing Address - Fax:502-499-2366
Practice Address - Street 1:9120 HURSTBOURNE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-1627
Practice Address - Country:US
Practice Address - Phone:502-491-3650
Practice Address - Fax:502-499-2366
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics