Provider Demographics
NPI:1629471313
Name:JANICE LIAO, DMD, INC
Entity Type:Organization
Organization Name:JANICE LIAO, DMD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:C
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:925-640-9546
Mailing Address - Street 1:3133 W MARCH LN STE 2010
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-2361
Mailing Address - Country:US
Mailing Address - Phone:209-472-8323
Mailing Address - Fax:
Practice Address - Street 1:3133 W MARCH LN STE 2010
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-2361
Practice Address - Country:US
Practice Address - Phone:209-472-8323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-08
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50949122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty