Provider Demographics
NPI:1316028004
Name:LI, JING (DMD)
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7370 SAWMILL RD
Mailing Address - Street 2:SAWMILL DENTAL CARE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1889
Mailing Address - Country:US
Mailing Address - Phone:614-889-0664
Mailing Address - Fax:614-889-0889
Practice Address - Street 1:7370 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1889
Practice Address - Country:US
Practice Address - Phone:614-889-0664
Practice Address - Fax:614-889-0889
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT94681223G0001X
OH30-0238491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice