MEDICARE: DR. SHITING LIAO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	105262	CA
2	1223G0001X	General Practice Dentistry	39003	TX

General Provider Information

NPI Number	:	1023604295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHITING LIAO DMD

Provider Business Mailing Address
First Line	:	4221 SANDHILLS LN
Second Line	:
City	:	PROSPER
State	:	TX
Zip	:	75078-0990
Country	:	US
Telephone Number	:	510-449-5875
Fax Number	:

Provider Business Practice Location Address
First Line	:	1525 US HIGHWAY 380 STE 600
Second Line	:
City	:	FRISCO
State	:	TX
Zip	:	75033-0176
Country	:	US
Telephone Number	:	214-225-0321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	03/18/2023

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Directions to “ DR. SHITING LIAO DMD” Practice Location

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