Provider Demographics
NPI:1679867196
Name:LIAO, MINDY D (DDS)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:D
Last Name:LIAO
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 1:10961 NORTH FWY # 104
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77038
Mailing Address - Country:US
Mailing Address - Phone:281-448-3384
Mailing Address - Fax:
Practice Address - Street 1:10961 NORTH FWY STE 104
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77037-1139
Practice Address - Country:US
Practice Address - Phone:281-448-3384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX263881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice