Provider Demographics
NPI:1881790780
Name:NEWKIRK, LISA A (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:NEWKIRK
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 1:8700 NE VANCOUVER MALL DR
Mailing Address - Street 2:SUITE 202A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6750
Mailing Address - Country:US
Mailing Address - Phone:360-254-8880
Mailing Address - Fax:360-254-8385
Practice Address - Street 1:8700 NE VANCOUVER MALL DR
Practice Address - Street 2:SUITE 202A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6750
Practice Address - Country:US
Practice Address - Phone:360-254-8880
Practice Address - Fax:360-254-8385
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008735122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5036074Medicaid