MEDICARE: LIANA MAH 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	30611	FL

General Provider Information

NPI Number	:	1548142615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIANA MAH DMD

Provider Business Mailing Address
First Line	:	2000 METROPICA WAY APT 2404
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-3228
Country	:	US
Telephone Number	:	250-686-0158
Fax Number	:

Provider Business Practice Location Address
First Line	:	6536 N UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4001
Country	:	US
Telephone Number	:	954-933-1705
Fax Number	:

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

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	08/01/2025

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