Provider Demographics
NPI:1982097556
Name:BUI, LIZ (RDH)
Entity Type:Individual
Prefix:
First Name:LIZ
Middle Name:
Last Name:BUI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 GRIFFIN RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7131
Mailing Address - Country:US
Mailing Address - Phone:603-498-6761
Mailing Address - Fax:
Practice Address - Street 1:150 GRIFFIN RD STE 1
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7131
Practice Address - Country:US
Practice Address - Phone:603-427-5122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02871124Q00000X
MADH87311124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist