Provider Demographics
NPI:1609052877
Name:ANDU, LISKA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISKA
Middle Name:M
Last Name:ANDU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 BUSBEE DR NW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-5511
Mailing Address - Country:US
Mailing Address - Phone:678-836-2115
Mailing Address - Fax:770-441-0299
Practice Address - Street 1:5026 WINDING HILLS LN
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-2582
Practice Address - Country:US
Practice Address - Phone:770-591-3947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011227122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist