Provider Demographics
NPI:1730697723
Name:SHASAN WILLIAM LIOU, DMD, LLC
Entity type:Organization
Organization Name:SHASAN WILLIAM LIOU, DMD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LIOU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:678-427-1412
Mailing Address - Street 1:10021 PINES BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6191
Mailing Address - Country:US
Mailing Address - Phone:844-304-5437
Mailing Address - Fax:
Practice Address - Street 1:12331 SW 3RD ST STE 5
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33325-2813
Practice Address - Country:US
Practice Address - Phone:844-304-5437
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN197431223P0221X
1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty