Provider Demographics
NPI:1013047000
Name:DOOCY, LIANNA MARIE (RDA)
Entity type:Individual
Prefix:MRS
First Name:LIANNA
Middle Name:MARIE
Last Name:DOOCY
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HILLCREST AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-451-0290
Mailing Address - Fax:507-451-0291
Practice Address - Street 1:605 HILLCREST AVE STE 130
Practice Address - Street 2:
Practice Address - City:OWATONNA
Practice Address - State:MN
Practice Address - Zip Code:55060-3680
Practice Address - Country:US
Practice Address - Phone:507-451-0290
Practice Address - Fax:507-451-0291
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA10219126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant