Provider Demographics
NPI:1881665883
Name:YURKIEWICZ, LISA ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:YURKIEWICZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1655 E HIGHWAY 50 STE 101
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-5056
Mailing Address - Country:US
Mailing Address - Phone:352-241-4884
Mailing Address - Fax:352-241-4882
Practice Address - Street 1:1655 E HIGHWAY 50 # 101
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5056
Practice Address - Country:US
Practice Address - Phone:352-241-4884
Practice Address - Fax:352-241-4882
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2009-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 132051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics