Provider Demographics
NPI:1780742486
Name:EMIRZIAN, LISA B (DMD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:EMIRZIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GERRARD AVENUE
Mailing Address - Street 2:
Mailing Address - City:E LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01028-1606
Mailing Address - Country:US
Mailing Address - Phone:413-732-6281
Mailing Address - Fax:413-731-8815
Practice Address - Street 1:16 GERRARD AVENUE
Practice Address - Street 2:
Practice Address - City:E LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-1606
Practice Address - Country:US
Practice Address - Phone:413-732-6281
Practice Address - Fax:413-731-8815
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice