Lisa Shilman, D.D.S

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN014054 Issued in GA

Practice address

12010 Etris Rd
Suite A100
Roswell, GA 30076

Phone

(678) 736-5980

Fax

(678) 736-5987

NPI assigned

Oct 19, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Lisa Klodnitskaya Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1224374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624838400000",
    "number": "1952553125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12010 ETRIS RD",
            "address_2": "SUITE A100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30076",
            "telephone_number": "678-736-5980",
            "fax_number": "678-736-5987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12010 ETRIS RD",
            "address_2": "SUITE A100",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "30076",
            "telephone_number": "678-736-5980",
            "fax_number": "678-736-5987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHILMAN",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-19",
        "last_updated": "2021-06-28",
        "certification_date": "2021-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NJ",
            "license": "22DI02376200",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014054",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "GA",
            "license": "DN014054",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "KLODNITSKAYA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Sherwood, LAPC
• Jigish G Sheth, DO
• Shaanan Satish Shetty, MD
• Shield Homecare
• Katherine Hufham Shiffer
• Hannah Elizabeth Shirling, BCBA
• Kristen E. Shoemaker, MAED, LPC
• Melissa B Shub, SLP
• Jill Shults, MMSC-CCC/SPEECH PATH
• James C. Shumans, PHARMD

• Pediatric Dentistry in Roswell, GA
• Providers in Roswell, GA by specialty
• Pediatric Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2021; 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.