Individual
JIE LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
1717 S CALHOUN ST, FORT WAYNE, IN 46802-5257
(260) 458-2641
Mailing address
6903 VISTAMERE WAY, INDIANAPOLIS, IN 46250-4156
(317) 750-3981
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13006783A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13006783A
LICENSE
IN
Enumeration date
04/16/2021
Last updated
04/16/2021
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