Provider Demographics
NPI:1902015407
Name:STEIN, LIANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIANA
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:LIANA
Other - Middle Name:
Other - Last Name:EVDAEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:85 TICES LN
Mailing Address - Street 2:APT 13
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2162
Mailing Address - Country:US
Mailing Address - Phone:973-783-4649
Mailing Address - Fax:
Practice Address - Street 1:190 BUCKELEW AVE
Practice Address - Street 2:
Practice Address - City:JAMESBURG
Practice Address - State:NJ
Practice Address - Zip Code:08831-1667
Practice Address - Country:US
Practice Address - Phone:732-521-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02308800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist