Provider Demographics
NPI:1134576424
Name:LIV DENTAL, PLLC
Entity type:Organization
Organization Name:LIV DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MANPREET
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:CHAHAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-321-9726
Mailing Address - Street 1:30003 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-1433
Mailing Address - Country:US
Mailing Address - Phone:248-646-2273
Mailing Address - Fax:248-646-2434
Practice Address - Street 1:30003 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-1433
Practice Address - Country:US
Practice Address - Phone:248-646-2273
Practice Address - Fax:248-646-2434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental