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Individual

LISA LIAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DMD

Contact information

Practice address
19 WILLS WAY, PISCATAWAY, NJ 08854-3770
(732) 733-2166
(732) 733-4012
Mailing address
19 WILLS WAY, PISCATAWAY, NJ 08854-3770
(732) 733-2166
(732) 733-4012

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
060110
NY
1223P0221X
Pediatric Dentistry
Primary
22DI02697300
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
060110
NEW YORK STATE DENTAL LICENSE
NY
01
22DI02697300
NEW JERSEY DENTAL LICENSE
NJ
Enumeration date
03/03/2016
Last updated
12/17/2024
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