NPIMap

Individual provider Active NPI

Lisa Dean, DMD

  • General Practice Dentistry
  • Russell, KY
National Provider Identifier
1972667137
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
0401418621 Issued in VA
Practice address
1592 Diederich Blvd
Russell, KY 41169-1676
Phone
(606) 836-9962
Fax
(606) 836-4668
NPI assigned
Dec 21, 2006
Last updated
Jun 6, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 0401418621 VA Primary
General Practice Dentistry 1223G0001X 6890 KY

Addresses

Primary practice location

1592 Diederich Blvd
Russell, KY 41169-1676

Mailing address

1592 Diederich Blvd
Russell, KY 41169-1676
Phone (606) 836-9962

Other identifiers 2

IdentifierTypeStateIssuer
2436288,9962MedicaidOH
60068905MedicaidKY

Other names 1

  • Lisa R. Dean Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200330001462 OH Practitioner - Dentist 5890087233 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6890KYMDGeneral Practice Dentistry
0401418621VAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Ironton & Lawrence County Area Community Action Organization CurrentSince Dec 31, 2019 Accepting new patients
Hopewell Health Centers, Inc. CurrentSince Dec 12, 2022 Accepting new patients
Ironton & Lawrence County Area Community Action Organization CurrentSince Dec 31, 2019 Accepting new patients
Ironton & Lawrence County Area Community Action Organization CurrentSince Dec 31, 2019 Accepting new patients
Hopewell Health Centers Inc Current Accepting new patients
Ironton & Lawrence County Area Community Action Organization Current Accepting new patients
Hopewell Health Centers Inc CurrentSince Dec 12, 2022 Accepting new patients
Community Action Committee of Pike County Past Accepting new patients
Bellefonte Family Dental Care, PSC General Practice Past Accepting new patients
Community Action Committee of Pike County Past Accepting new patients
Community Action Committee of Pike County Past Accepting new patients
Community Action Committee of Pike County Past Accepting new patients

Locations

90 Hospital Dr
Athens, OH 45701
Phone (740) 592-3091

3086 State Route 160
Gallipolis, OH 45631
Phone (740) 446-5500

120 N 3rd St
Ironton, OH 45638
Phone (740) 532-7855

1408 Campbell Dr
#201
Ironton, OH 45638
Phone (740) 534-9195

305 N 5th St
Ironton, OH 45638

10777 County Road 107
Proctorville, OH 45669
Phone (740) 302-0541

Organizations & group practices 12

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

NPI Registry JSON

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

{
    "created_epoch": "1166659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1972667137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1592 DIEDERICH BLVD",
            "city": "RUSSELL",
            "state": "KY",
            "postal_code": "411691676",
            "telephone_number": "606-836-9962",
            "fax_number": "606-836-4668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1592 DIEDERICH BLVD",
            "city": "RUSSELL",
            "state": "KY",
            "postal_code": "411691676",
            "telephone_number": "606-836-9962",
            "fax_number": "606-836-4668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAN",
        "first_name": "LISA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-21",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401418621",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "6890",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2436288,9962",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60068905",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "DEAN",
            "middle_name": "R.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Russell, KY

Sources for this page

Verify at the official NPI Registry.