Provider Demographics
NPI:1881894376
Name:KISPERT, LISA S (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:S
Last Name:KISPERT
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:S
Other - Last Name:YARBOROUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3605 GRANT DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5301
Mailing Address - Country:US
Mailing Address - Phone:775-409-4614
Mailing Address - Fax:774-409-4614
Practice Address - Street 1:18803 SW BOONES FERRY RD STE 5
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8412
Practice Address - Country:US
Practice Address - Phone:036-923-7475
Practice Address - Fax:503-612-6948
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9222122300000X, 1223P0221X
WADE00011251122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist