=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629471313
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANICE LIAO, DMD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/08/2014
-----------------------------------------------------
Last Update Date | 10/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3133 W MARCH LN STE 2010
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95219-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-472-8323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3133 W MARCH LN STE 2010
-----------------------------------------------------
City | STOCKTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95219-2361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-472-8323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JANICE C LIAO
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 925-640-9546
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 50949
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------