| Lisa Gushin D.d.s. P.a. | |
|
203 Owen Dr Fayetteville NC 28304-3409 | |
| (910) 484-1771 | |
| (910) 484-8876 |
| Full Name | Lisa Gushin D.d.s. P.a. |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 203 Owen Dr, Fayetteville, North Carolina |
| Authorized Official Name and Position | Lisa Gushin (PRESIDENT) |
| Authorized Official Contact | 9104841771 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisa Gushin D.d.s. P.a. 203 Owen Dr Fayetteville NC 28304-3409 Ph: (910) 484-1771 | Lisa Gushin D.d.s. P.a. 203 Owen Dr Fayetteville NC 28304-3409 Ph: (910) 484-1771 |
| NPI Number | 1558548875 |
|---|---|
| Provider Enumeration Date | 01/29/2008 |
| Last Update Date | 01/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558548875 | NPI | - | NPPES |
| 899010F | Medicaid | NC | |
| 9010F | Other | NC | BCBS |
| 586286 | Other | NC | UNITED CONCORDIA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 6908 (North Carolina) | Primary |
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