Healthcare Provider Details

I. General information

NPI: 1104273069
Provider Name (Legal Business Name): LIAO DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E LOHMAN AVE
LAS CRUCES NM
88001-3667
US

IV. Provider business mailing address

301 E LOHMAN AVE
LAS CRUCES NM
88001-3667
US

V. Phone/Fax

Practice location:
  • Phone: 575-524-4900
  • Fax:
Mailing address:
  • Phone: 575-524-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3535
License Number StateNM

VIII. Authorized Official

Name: DR. WEN LIAO
Title or Position: GENERAL DENTIST
Credential: DDS
Phone: 575-528-9698