Provider Demographics
NPI:1770899858
Name:LISH, JAMES C (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:LISH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9601 6TH BAY ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-1107
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1647 ADM TAUSSIG BLVD
Practice Address - Street 2:ATTN DR. LISH
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518
Practice Address - Country:US
Practice Address - Phone:757-953-8506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014178331223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics