Healthcare Provider Details

I. General information

NPI: 1154187482
Provider Name (Legal Business Name): FLORENCE LIAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST
BOSTON MA
02111-1527
US

IV. Provider business mailing address

916 DELAWARE AVE APT 3H
BUFFALO NY
14209-1852
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6828
  • Fax:
Mailing address:
  • Phone: 949-822-5831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number065765
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: