Provider Demographics
NPI:1518588847
Name:RACELIS, LIANE (DDS)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:
Last Name:RACELIS
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 1:2365 S HURON PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-5156
Mailing Address - Country:US
Mailing Address - Phone:734-677-8700
Mailing Address - Fax:734-839-4137
Practice Address - Street 1:1795 W STADIUM BLVD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5290
Practice Address - Country:US
Practice Address - Phone:734-662-3222
Practice Address - Fax:734-839-4137
Is Sole Proprietor?:No
Enumeration Date:2020-04-28
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901600524APP20122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist