Provider Demographics
NPI:1306058615
Name:SIE, LIE H (DDS)
Entity type:Individual
Prefix:
First Name:LIE
Middle Name:H
Last Name:SIE
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 1:1038 S GLENDORA AVE
Mailing Address - Street 2:STE. 3
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4966
Mailing Address - Country:US
Mailing Address - Phone:626-918-6644
Mailing Address - Fax:
Practice Address - Street 1:1038 S GLENDORA AVE
Practice Address - Street 2:STE. 3
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4966
Practice Address - Country:US
Practice Address - Phone:626-918-6644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA360001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice