Provider Demographics
NPI:1194250209
Name:LI DENTAL ASSOCIATION
Entity type:Organization
Organization Name:LI DENTAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WEI
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-947-5300
Mailing Address - Street 1:11908 DARNESTOWN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2295
Mailing Address - Country:US
Mailing Address - Phone:301-947-5300
Mailing Address - Fax:301-947-9720
Practice Address - Street 1:11908 DARNESTOWN RD
Practice Address - Street 2:SUITE E
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-2295
Practice Address - Country:US
Practice Address - Phone:301-947-5300
Practice Address - Fax:301-947-9720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160771223G0001X
MD118981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty