Healthcare Provider Details

I. General information

NPI: 1114506326
Provider Name (Legal Business Name): DR. ANNA LIANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N GRAND BLVD
SAINT LOUIS MO
63106-1621
US

IV. Provider business mailing address

4326 PINEHURST BLVD
SOUTHAVEN MS
38672-6687
US

V. Phone/Fax

Practice location:
  • Phone: 314-289-7675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number61304113
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: