Provider Demographics
NPI:1215017421
Name:VAN, LIEN T (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIEN
Middle Name:T
Last Name:VAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 ALAFAYA WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6235
Mailing Address - Country:US
Mailing Address - Phone:407-977-9888
Mailing Address - Fax:407-977-7163
Practice Address - Street 1:83 ALAFAYA WOODS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6235
Practice Address - Country:US
Practice Address - Phone:407-977-9888
Practice Address - Fax:407-977-7163
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL16866122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist