1891870150 NPI number — LISA ANN ALVETRO ROSSMAN DDS MSD

Table of content: LISA ANN ALVETRO ROSSMAN DDS MSD (NPI 1891870150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891870150 NPI number — LISA ANN ALVETRO ROSSMAN DDS MSD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALVETRO ROSSMAN
Provider First Name:
LISA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS MSD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALVETRO
Provider Other First Name:
LISA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS MSD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1891870150
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1102 FAIRINGTON DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIDNEY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45365
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-492-3200
Provider Business Mailing Address Fax Number:
937-497-7121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1102 FAIRINGTON DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SIDNEY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-492-3200
Provider Business Practice Location Address Fax Number:
937-497-7121
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  19878 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com