Provider Demographics
NPI:1114301116
Name:IDEAL DENTAL AT WEST LITTLE YORK
Entity Type:Organization
Organization Name:IDEAL DENTAL AT WEST LITTLE YORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-316-0369
Mailing Address - Street 1:216 W LITTLE YORK RD
Mailing Address - Street 2:STE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77076-1432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 W LITTLE YORK RD
Practice Address - Street 2:STE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77076-1432
Practice Address - Country:US
Practice Address - Phone:832-458-1068
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty