Healthcare Provider Details

I. General information

NPI: 1093633281
Provider Name (Legal Business Name): SIDNEY LI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6290 ABBOTTS BRIDGE RD STE 101
JOHNS CREEK GA
30097-1750
US

IV. Provider business mailing address

11130 MEDLOCK BRIDGE RD APT 1126
JOHNS CREEK GA
30097-8503
US

V. Phone/Fax

Practice location:
  • Phone: 770-418-1771
  • Fax:
Mailing address:
  • Phone: 513-649-7462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124237
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: