Healthcare Provider Details

I. General information

NPI: 1730939349
Provider Name (Legal Business Name): ZHENGENG LIANG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 E DIXIE DR
ASHEBORO NC
27203-5080
US

IV. Provider business mailing address

323 N 24TH ST APT 103
OMAHA NE
68102-1257
US

V. Phone/Fax

Practice location:
  • Phone: 336-308-1202
  • Fax:
Mailing address:
  • Phone: 402-972-5284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13853
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: