Provider Demographics
NPI:1811182603
Name:DAVISON, LISA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE
Last Name:DAVISON
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 1:395 W OLENTANGY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8719
Mailing Address - Country:US
Mailing Address - Phone:614-389-8346
Mailing Address - Fax:
Practice Address - Street 1:395 W OLENTANGY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8719
Practice Address - Country:US
Practice Address - Phone:614-389-8346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0226411223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics