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General NPI Number Information
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NPI Number | 1942666284
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Entity Type | Organization
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Legal Business Name | LIWEN TAO D.D.S., M.S.
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Dates
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Enumeration Date | 12/31/2015
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 2753 STATE ROAD 580 STE 108
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City | CLEARWATER
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State | FL
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Zip | 33761-3351
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Country | US
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Telephone | 727-799-6995
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Fax |
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Provider Business Mailing Address
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Address Line | 2753 STATE ROAD 580 STE 108
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City | CLEARWATER
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State | FL
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Zip | 33761-3351
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Country | US
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Telephone | 727-799-6995
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Fax |
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Authorized Official
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Title or Position | DR
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Name | LIWEN TAO
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Credential | DDS
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Telephone | 727-799-6995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN0012253
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License Number State | FL
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