Provider Demographics
NPI:1306108832
Name:DO, HOANG LISA (DMD)
Entity type:Individual
Prefix:DR
First Name:HOANG
Middle Name:LISA
Last Name:DO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CONCETTA SASS DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-6010
Mailing Address - Country:US
Mailing Address - Phone:617-259-8600
Mailing Address - Fax:
Practice Address - Street 1:40 JACKSON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5000
Practice Address - Country:US
Practice Address - Phone:978-682-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1855970122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist