Healthcare Provider Details

I. General information

NPI: 1396266417
Provider Name (Legal Business Name): LIANJIE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2017
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9188 E SAN SALVADOR DR STE 105
SCOTTSDALE AZ
85258-5534
US

IV. Provider business mailing address

PO BOX 61025
PHOENIX AZ
85082-1025
US

V. Phone/Fax

Practice location:
  • Phone: 602-225-0595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: MONICA DEWITT
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 602-914-4274