Provider Demographics
NPI:1548274269
Name:ADORNETTO, LISA JO
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:JO
Last Name:ADORNETTO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3861 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9438
Mailing Address - Country:US
Mailing Address - Phone:336-855-7185
Mailing Address - Fax:336-288-1169
Practice Address - Street 1:3861 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9438
Practice Address - Country:US
Practice Address - Phone:336-855-7185
Practice Address - Fax:336-288-1169
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC57891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice