Provider Demographics
NPI:1154590123
Name:URREGO, LIA P (DDS)
Entity type:Individual
Prefix:DR
First Name:LIA
Middle Name:P
Last Name:URREGO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:950 WASHINGTON ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3542
Mailing Address - Country:US
Mailing Address - Phone:770-534-6933
Mailing Address - Fax:770-535-7882
Practice Address - Street 1:950 WASHINGTON ST
Practice Address - Street 2:SUITE J
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3542
Practice Address - Country:US
Practice Address - Phone:770-534-6933
Practice Address - Fax:770-535-7882
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0136771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice