NPI 1588739775

Lisa Devalder, RDH

Practitioner Dental Hygienist Brockport, NY

Practice location

Address: 300 West Ave, Brockport, NY 14420-1118
Phone: (585) 637-3905
Fax: (585) 637-4990

Registered specialties

Dental Hygienist Primary

Dental Providers Taxonomy 124Q00000X Licence 024262-1 (NY)

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Registry record

NPI: 1588739775
Entity type: Individual
Sex (as registered): Female
NPI issued: 22 Nov 2006
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.