Provider Demographics
NPI:1174152078
Name:LIZUNIENE, LIGITA (RDH)
Entity type:Individual
Prefix:
First Name:LIGITA
Middle Name:
Last Name:LIZUNIENE
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 1:120 TREADSTONE OVERLOOK
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1530
Mailing Address - Country:US
Mailing Address - Phone:404-259-5286
Mailing Address - Fax:
Practice Address - Street 1:3705 OLD NORCROSS RD STE 300
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4336
Practice Address - Country:US
Practice Address - Phone:770-813-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADH009913124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist