Provider Demographics
NPI:1740255777
Name:THURLOW, LISA A (DDS)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:THURLOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:NOVAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5329 W 94TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66207
Mailing Address - Country:US
Mailing Address - Phone:913-341-7440
Mailing Address - Fax:913-341-6220
Practice Address - Street 1:5329 W 94TH TERRACE
Practice Address - Street 2:
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66207
Practice Address - Country:US
Practice Address - Phone:913-341-7440
Practice Address - Fax:913-341-6220
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6925122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS449032OtherBCBS KS
KS21597040OtherBCBS KC
889089OtherUNITED CONCORDIA