Provider Demographics
NPI:1952512600
Name:KADUK, LISA ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:ELIZABETH
Last Name:KADUK
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 1:6040 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-3229
Mailing Address - Country:US
Mailing Address - Phone:727-856-7461
Mailing Address - Fax:727-817-0428
Practice Address - Street 1:6040 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-3229
Practice Address - Country:US
Practice Address - Phone:727-856-7461
Practice Address - Fax:727-817-0428
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 15615122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist