Provider Demographics
NPI:1558593590
Name:AMATYA, LIZA (DDS)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:AMATYA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:SHRESTHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BDS
Mailing Address - Street 1:22819 LAKEMONT PL
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94552-5420
Mailing Address - Country:US
Mailing Address - Phone:510-583-1476
Mailing Address - Fax:
Practice Address - Street 1:22819 LAKEMONT PL
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94552-5420
Practice Address - Country:US
Practice Address - Phone:510-583-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-09
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58638122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist