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General NPI Number Information
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NPI Number | 1366038499
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Entity Type | Organization
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Legal Business Name | RAPHAEL LIY DDS LLC
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Dates
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Enumeration Date | 12/13/2020
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 1822 HEALTH CARE DR BLDG 6
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City | TRINITY
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State | FL
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Zip | 34655-5362
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Country | US
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Telephone | 727-848-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 1822 HEALTH CARE DR BLDG 6
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City | TRINITY
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State | FL
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Zip | 34655-5362
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Country | US
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Telephone | 727-848-5525
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. RAPHAEL LIY
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Credential | DDS
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Telephone | 727-848-5525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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