Provider Demographics
NPI:1669404299
Name:MARX, LISA AMEER (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:AMEER
Last Name:MARX
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:AMEER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:420 SOUTH STATE ROAD 7
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-798-4998
Mailing Address - Fax:561-798-4996
Practice Address - Street 1:420 SOUTH STATE ROAD 7
Practice Address - Street 2:SUITE 140
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-798-4998
Practice Address - Fax:561-798-4996
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 171191223G0001X
FLDN171191223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice