Provider Demographics
NPI:1003782665
Name:BUFFALO LIPTZ
Entity type:Organization
Organization Name:BUFFALO LIPTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-696-9918
Mailing Address - Street 1:1815 MONTAGUE AVENUE EXT UNIT 1
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-9051
Mailing Address - Country:US
Mailing Address - Phone:864-223-1152
Mailing Address - Fax:
Practice Address - Street 1:1815 MONTAGUE AVENUE EXT UNIT 1
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-9051
Practice Address - Country:US
Practice Address - Phone:864-223-1152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty