Provider Demographics
NPI:1205901972
Name:ARNHART, LISA WASHBURN (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:WASHBURN
Last Name:ARNHART
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 1:8521 GOLF COURSE RD NW STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4549
Mailing Address - Country:US
Mailing Address - Phone:505-897-6453
Mailing Address - Fax:505-897-8027
Practice Address - Street 1:8521 GOLF COURSE RD NW STE 116
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-4549
Practice Address - Country:US
Practice Address - Phone:505-897-6453
Practice Address - Fax:505-897-8027
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM18921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1861456477Medicare UPIN