1023604295 NPI number — DR. SHITING LIAO DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023604295 NPI number — DR. SHITING LIAO DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIAO
Provider First Name:
SHITING
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIAO
Provider Other First Name:
AMY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023604295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4221 SANDHILLS LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSPER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75078-0990
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-449-5875
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1525 US HIGHWAY 380 STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75033-0176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-225-0321
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  105262 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 39003 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)