Individual
WANNI LIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10870 W CHARLESTON BLVD STE 170, LAS VEGAS, NV 89135-1170
(702) 254-6412
Mailing address
1504 TRUETT ST UNIT 101, LAS VEGAS, NV 89128-8074
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6920
NV
1223G0001X
General Practice Dentistry
Primary
6920
NV
Other
Enumeration date
06/08/2017
Last updated
06/08/2017
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