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NPI Code Detail

MEDICARE: WANNI LIE

MEDICARE: WANNI LIE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6920NV
21223G0001XGeneral Practice Dentistry6920NV

General Provider Information

NPI Number : 1073042446
Entity Type Code : Individual
Provider Name (Legal Business Name) : WANNI LIE
Provider Business Mailing Address
First Line : 1504 TRUETT ST UNIT 101
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-8074
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10870 W CHARLESTON BLVD STE 170
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1170
Country : US
Telephone Number : 702-254-6412
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2017
Last Update Date : 06/08/2017

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Directions to “ WANNI LIE ” Practice Location

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