Provider Demographics
NPI:1184828089
Name:REN, LIANG (DDS)
Entity Type:Individual
Prefix:
First Name:LIANG
Middle Name:
Last Name:REN
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 1:1501 SUPERIOR AVE
Mailing Address - Street 2:306
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3600
Mailing Address - Country:US
Mailing Address - Phone:949-218-1408
Mailing Address - Fax:949-218-1410
Practice Address - Street 1:1501 SUPERIOR AVE
Practice Address - Street 2:SUITE306
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3600
Practice Address - Country:US
Practice Address - Phone:949-218-1408
Practice Address - Fax:949-218-1410
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice