Provider Demographics
NPI:1598155210
Name:LI, ALANNA (DDS)
Entity Type:Individual
Prefix:
First Name:ALANNA
Middle Name:
Last Name:LI
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 1:4211 KISSENA BLVD
Mailing Address - Street 2:1D
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3223
Mailing Address - Country:US
Mailing Address - Phone:718-353-5504
Mailing Address - Fax:
Practice Address - Street 1:4211 KISSENA BLVD
Practice Address - Street 2:1D
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3223
Practice Address - Country:US
Practice Address - Phone:718-353-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY057952122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist