Provider Demographics
NPI:1073500617
Name:LI, BIAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BIAO
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MIZE RD SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-5729
Mailing Address - Country:US
Mailing Address - Phone:503-364-7776
Mailing Address - Fax:503-364-4445
Practice Address - Street 1:120 MIZE RD SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-5729
Practice Address - Country:US
Practice Address - Phone:503-364-7776
Practice Address - Fax:503-364-4445
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD85871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice