Provider Demographics
NPI:1750774485
Name:LIERLY, REI (DDS)
Entity type:Individual
Prefix:DR
First Name:REI
Middle Name:
Last Name:LIERLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:REI
Other - Middle Name:
Other - Last Name:IWASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4552 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-4725
Mailing Address - Country:US
Mailing Address - Phone:469-774-3106
Mailing Address - Fax:
Practice Address - Street 1:4552 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-4725
Practice Address - Country:US
Practice Address - Phone:469-774-3106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-04
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX325481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program