Provider Demographics
NPI:1952553125
Name:SHILMAN, LISA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:SHILMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KLODNITSKAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12010 ETRIS RD
Mailing Address - Street 2:SUITE A100
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076
Mailing Address - Country:US
Mailing Address - Phone:678-736-5980
Mailing Address - Fax:678-736-5987
Practice Address - Street 1:12010 ETRIS RD
Practice Address - Street 2:SUITE A100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076
Practice Address - Country:US
Practice Address - Phone:678-736-5980
Practice Address - Fax:678-736-5987
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-19
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02376200122300000X
GADN014054122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist