Provider Demographics
NPI:1548343544
Name:MCDONALD, LISA J (DMD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:J
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:7247 DELMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130-4105
Mailing Address - Country:US
Mailing Address - Phone:314-727-1319
Mailing Address - Fax:
Practice Address - Street 1:7247 DELMAR BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63130-4105
Practice Address - Country:US
Practice Address - Phone:314-727-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010220201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice