Provider Demographics
NPI:1669718417
Name:LISA M. ANDERSON, DDS, MS, INCO
Entity type:Organization
Organization Name:LISA M. ANDERSON, DDS, MS, INCO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MURPHY
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-255-6511
Mailing Address - Street 1:19100 COX AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-6602
Mailing Address - Country:US
Mailing Address - Phone:408-255-6511
Mailing Address - Fax:408-255-9695
Practice Address - Street 1:19100 COX AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-6602
Practice Address - Country:US
Practice Address - Phone:408-255-6511
Practice Address - Fax:408-255-9695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58038261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental