Provider Demographics
NPI:1295439768
Name:LIA DENTAL, PC
Entity type:Organization
Organization Name:LIA DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHNAAZ
Authorized Official - Middle Name:
Authorized Official - Last Name:NISTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:917-892-3625
Mailing Address - Street 1:61 DUDLEY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4007
Mailing Address - Country:US
Mailing Address - Phone:917-892-3625
Mailing Address - Fax:
Practice Address - Street 1:79 LYNNFIELD ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-5201
Practice Address - Country:US
Practice Address - Phone:917-892-3625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty