Provider Demographics
NPI:1801985957
Name:PERIU, LIE-YING (DMD)
Entity type:Individual
Prefix:
First Name:LIE-YING
Middle Name:
Last Name:PERIU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6765 N WICKHAM RD
Mailing Address - Street 2:SUITE C105
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2022
Mailing Address - Country:US
Mailing Address - Phone:321-622-8960
Mailing Address - Fax:321-622-8961
Practice Address - Street 1:6765 N WICKHAM RD
Practice Address - Street 2:SUITE C105
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2022
Practice Address - Country:US
Practice Address - Phone:321-622-8960
Practice Address - Fax:321-622-8961
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice