Provider Demographics
NPI:1003652298
Name:SHAO, LIANG (DDS)
Entity type:Individual
Prefix:DR
First Name:LIANG
Middle Name:
Last Name:SHAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:
Other - Last Name:SHAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:325 5TH AVE APT 28A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5043
Mailing Address - Country:US
Mailing Address - Phone:347-863-3635
Mailing Address - Fax:
Practice Address - Street 1:754 S BROADWAY
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-5017
Practice Address - Country:US
Practice Address - Phone:516-874-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-08
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0647251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice