| Doctor Name: | DR. MARK STEVEN LISAGOR |
| NPI Number: | 1003968934 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.D.S. |
| License Number: | D23636 |
| Business Practice Address: | 3687 Las Posas Rd #180 Camarillo, CA - 930101482 |
| Business Phone Number: | 8054842705 |
| Business Fax Number: | 8054845908 |
| Mailing Address: | 477 Calle Higuera, CAMARILLO |
| State: | CA |
| Postal Code: | 930101812 |
| Phone Number: | 8054843928 |
| Fax Number: | 8053881258 |
| NPI Enumeration Date: | 01/18/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1223P0221X |
| License Number: | D23636 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Dental Providers |
| Taxonomy Classification: | Dentist |
| Taxonomy Specialization: | Pediatric Dentistry |
| Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |