Provider Demographics
NPI:1962672642
Name:XIAO, WANLAN (DDS)
Entity Type:Individual
Prefix:
First Name:WANLAN
Middle Name:
Last Name:XIAO
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 1:39 S LIVERMORE AVE
Mailing Address - Street 2:SUITE 217
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-3119
Mailing Address - Country:US
Mailing Address - Phone:925-373-7311
Mailing Address - Fax:925-373-7310
Practice Address - Street 1:39 S LIVERMORE AVE
Practice Address - Street 2:SUITE 217
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-3119
Practice Address - Country:US
Practice Address - Phone:925-373-7311
Practice Address - Fax:925-373-7310
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA538901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice