Provider Demographics
NPI:1265634000
Name:ALEX LIAO, DDS, INC
Entity Type:Organization
Organization Name:ALEX LIAO, DDS, INC
Other - Org Name:U SMILE DENTAL OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC RELATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:VIKKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-812-6612
Mailing Address - Street 1:680 E ALOSTA AVE #108
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702
Mailing Address - Country:US
Mailing Address - Phone:626-812-6612
Mailing Address - Fax:626-812-6634
Practice Address - Street 1:680 E ALOSTA AVE STE 108
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-2710
Practice Address - Country:US
Practice Address - Phone:626-812-6612
Practice Address - Fax:626-812-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45136OtherDENTISTRY