Individual
DR. LIA DATIKASHVILI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
293 E 149TH ST, BRONX, NY 10451-5601
(646) 404-5005
Mailing address
293 E 149TH ST, BRONX, NY 10451-5601
(646) 404-5005
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055422-1
NY
122300000X
Dentist
22DI02125000
NJ
Other
Enumeration date
05/20/2011
Last updated
05/20/2011
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