Provider Demographics
NPI:1942666284
Name:LIWEN TAO D.D.S., M.S.
Entity Type:Organization
Organization Name:LIWEN TAO D.D.S., M.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:LIWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-799-6995
Mailing Address - Street 1:2753 STATE ROAD 580 STE 108
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3351
Mailing Address - Country:US
Mailing Address - Phone:727-799-6995
Mailing Address - Fax:
Practice Address - Street 1:2753 STATE ROAD 580 STE 108
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3351
Practice Address - Country:US
Practice Address - Phone:727-799-6995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00122531223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty