Provider Demographics
NPI:1962586602
Name:MICHAEL D LIANGCO DENTAL CORPORATION
Entity type:Organization
Organization Name:MICHAEL D LIANGCO DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LIANGCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-893-2800
Mailing Address - Street 1:14417 ROSCOE BLVD
Mailing Address - Street 2:E
Mailing Address - City:PANDORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402
Mailing Address - Country:US
Mailing Address - Phone:818-893-2800
Mailing Address - Fax:818-893-2805
Practice Address - Street 1:14417 ROSCOE BLVD
Practice Address - Street 2:E
Practice Address - City:PANDORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402
Practice Address - Country:US
Practice Address - Phone:818-893-2800
Practice Address - Fax:818-893-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48636OtherDENTIST