Provider Demographics
NPI:1447685771
Name:PERRONE, LISA CAROL (PHD, DDS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:CAROL
Last Name:PERRONE
Suffix:
Gender:F
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 E BLUEBIRD CT
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2755
Mailing Address - Country:US
Mailing Address - Phone:808-343-1553
Mailing Address - Fax:
Practice Address - Street 1:FHCC LOVELL BLDG 237 DENTAL
Practice Address - Street 2:NAVSTA GREAT LAKES
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60088
Practice Address - Country:US
Practice Address - Phone:847-688-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILINPROCESS1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice