Lisa S Kispert, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D9222 Issued in OR

Practice address

18803 SW Boones Ferry Rd Ste 5
Tualatin, OR 97062-8412

Phone

(036) 923-7475

Fax

(503) 612-6948

NPI assigned

Jul 23, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Lisa S Yarborough Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tualatin Pediatric Dentistry

  • Dental Clinic/Center
  • Tualatin, OR
  • NPI 1255762449
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740528000000",
    "number": "1881894376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3605 GRANT DR",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895095301",
            "telephone_number": "775-409-4614",
            "fax_number": "774-409-4614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18803 SW BOONES FERRY RD STE 5",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970628412",
            "telephone_number": "036-923-7475",
            "fax_number": "503-612-6948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISPERT",
        "first_name": "LISA",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-23",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D9222",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00011251",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "OR",
            "license": "D9222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "YARBOROUGH",
            "middle_name": "S",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather J Kinney, D.C.
• Jonathan Thomas Kinney, D.C.
• Amanda Kirchem, LMT
• Wilson Paul Kisambira
• Kimberly Li Ching Michiko Kisor, M.D.
• Kkrueger Corporation (krueger healthcare products)
• Paul A Klas, M.D.
• Kleiman Healthcare Services
• Lindsay Kate Kleps, FNP
• Nadezda Klineva, COTA

• Pediatric Dentistry in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Pediatric Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.