Provider Demographics
NPI:1700015542
Name:LI, XUEWEI (DDS)
Entity Type:Individual
Prefix:
First Name:XUEWEI
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 1:9256 BENDIX RD
Mailing Address - Street 2:STE 303
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1840
Mailing Address - Country:US
Mailing Address - Phone:443-319-5167
Mailing Address - Fax:443-319-5043
Practice Address - Street 1:9256 BENDIX RD
Practice Address - Street 2:STE 303
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1840
Practice Address - Country:US
Practice Address - Phone:443-319-5167
Practice Address - Fax:443-319-5043
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14539122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD036416900Medicaid