Provider Demographics
NPI:1518081587
Name:JOSHUA S. LIAO, D.D.S. INC
Entity Type:Organization
Organization Name:JOSHUA S. LIAO, D.D.S. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-614-0909
Mailing Address - Street 1:1140 S SAN GABRIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3115
Mailing Address - Country:US
Mailing Address - Phone:626-614-0909
Mailing Address - Fax:626-614-0191
Practice Address - Street 1:1140 S SAN GABRIEL BLVD
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3115
Practice Address - Country:US
Practice Address - Phone:626-614-0909
Practice Address - Fax:626-614-0191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91827-01OtherDENTI-CAL