Provider Demographics
NPI:1487718243
Name:BOZZETTI, LISA LOUISE (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LOUISE
Last Name:BOZZETTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 SE OAK ST STE A
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4245
Mailing Address - Country:US
Mailing Address - Phone:503-352-2361
Mailing Address - Fax:503-352-2363
Practice Address - Street 1:730 SE OAK ST STE A
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4245
Practice Address - Country:US
Practice Address - Phone:503-352-2361
Practice Address - Fax:503-352-2363
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD81491223G0001X
CA512321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice