Provider Demographics
NPI:1548673809
Name:QIAN, LI
Entity type:Individual
Prefix:DR
First Name:LI
Middle Name:
Last Name:QIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 N ROXBORO ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-5800
Mailing Address - Country:US
Mailing Address - Phone:919-477-3369
Mailing Address - Fax:919-479-1610
Practice Address - Street 1:3811 N ROXBORO ST
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-5800
Practice Address - Country:US
Practice Address - Phone:919-477-3369
Practice Address - Fax:919-479-1610
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice