Provider Demographics
NPI:1023604295
Name:LIAO, SHITING (DMD)
Entity type:Individual
Prefix:DR
First Name:SHITING
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:LIAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4221 SANDHILLS LN
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-0990
Mailing Address - Country:US
Mailing Address - Phone:510-449-5875
Mailing Address - Fax:
Practice Address - Street 1:1525 US HIGHWAY 380 STE 600
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0176
Practice Address - Country:US
Practice Address - Phone:214-225-0321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-11
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1052621223G0001X
TX390031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice