Provider Demographics
NPI:1508235912
Name:LIANA GROZA DDS PLLC
Entity Type:Organization
Organization Name:LIANA GROZA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-481-3392
Mailing Address - Street 1:12213 E BROADWAY AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-6131
Mailing Address - Country:US
Mailing Address - Phone:509-290-6044
Mailing Address - Fax:509-443-3928
Practice Address - Street 1:12213 E BROADWAY AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-6131
Practice Address - Country:US
Practice Address - Phone:509-290-6044
Practice Address - Fax:509-443-3928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000106731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty