Provider Demographics
NPI:1063175230
Name:LIANG, ELLEN JIACHEN (DDS)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JIACHEN
Last Name:LIANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9950 W TROPICANA AVE APT 1052
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89147-8543
Mailing Address - Country:US
Mailing Address - Phone:415-815-6218
Mailing Address - Fax:
Practice Address - Street 1:7181 N HUALAPAI WAY STE 105
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-1116
Practice Address - Country:US
Practice Address - Phone:702-703-8609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV75681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice