Provider Demographics
NPI:1396905428
Name:SPINK, LISA SABIENNE (DMD, MDSC, FACP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:SABIENNE
Last Name:SPINK
Suffix:
Gender:F
Credentials:DMD, MDSC, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 DELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-6717
Mailing Address - Country:US
Mailing Address - Phone:971-219-0230
Mailing Address - Fax:
Practice Address - Street 1:454 A AVE
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-3038
Practice Address - Country:US
Practice Address - Phone:503-636-3066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORD92711223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program