Healthcare Provider Details

I. General information

NPI: 1245257294
Provider Name (Legal Business Name): LIANA GEDZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 40TH ST RM 207
NEW YORK NY
10016-1222
US

IV. Provider business mailing address

30 E 40TH ST RM 207
NEW YORK NY
10016-1222
US

V. Phone/Fax

Practice location:
  • Phone: 212-696-4979
  • Fax: 212-447-5786
Mailing address:
  • Phone: 212-696-4979
  • Fax: 212-447-5786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number046212-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: