Provider Demographics
NPI:1457570103
Name:BROWNING, LISA BLONDELL (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:BLONDELL
Last Name:BROWNING
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 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-855-8882
Practice Address - Street 1:6101 LAKE ELLENOR DR # 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4616
Practice Address - Country:US
Practice Address - Phone:407-956-4660
Practice Address - Fax:407-855-8882
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN128701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075116200Medicaid