Provider Demographics
NPI:1356693402
Name:DENTAL ASSOCIATES OF LODI
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF LODI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HUA-YU STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-757-5516
Mailing Address - Street 1:147 MAIN ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1715
Mailing Address - Country:US
Mailing Address - Phone:862-247-8030
Mailing Address - Fax:862-247-8032
Practice Address - Street 1:147 MAIN ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1715
Practice Address - Country:US
Practice Address - Phone:862-247-8030
Practice Address - Fax:862-247-8032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI023832001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty