Lisa Kay Mulkin, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

050514-1 Issued in NY

Practice address

404 William St
Geneva, NY 14456-2143

Phone

(315) 789-3067

Fax

(315) 789-0056

NPI assigned

Aug 30, 2006

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 identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 2, 2016 through Feb 2, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Lake Country Dental P.L.L.C

  • Dental Clinic/Center
  • Geneva, NY
  • NPI 1396274452
  NPD Authorized official

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1902916307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 WILLIAM ST",
            "city": "GENEVA",
            "state": "NY",
            "postal_code": "144562143",
            "telephone_number": "315-789-3067",
            "fax_number": "315-789-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 WILLIAM ST",
            "city": "GENEVA",
            "state": "NY",
            "postal_code": "144562143",
            "telephone_number": "315-789-3067",
            "fax_number": "315-789-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULKIN",
        "first_name": "LISA",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-03-07",
        "certification_date": "2021-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "050514-1",
            "primary": false
        },
        {
            "code": "1223X2210X",
            "taxonomy_group": "",
            "desc": "Dentist, Orofacial Pain",
            "state": "NY",
            "license": "050514-1",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "050514-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEW YORK STATE LICENSE",
            "identifier": "050514",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS PROVIDER NUMBER",
            "identifier": "70455LM",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deven Moore
• Sara Amalia Moore, MAT, ATC
• Kathryn Lynn Morgan, NP
• Rosie E Morlang, LPN
• Martha Grace Mosher, R.PH.
• Shirley A Mumford
• Jill Mundy
• Jordyn E Mundy, DPT
• Jennifer Mungari, M.D.
• Deborah Murad, LMSW

• Oral and Maxillofacial Surgery (Dentist) in Geneva, NY
• Providers in Geneva, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.