Wanni Lie

NPI #1073042446 in Las Vegas, Nevada

Provider Information

NPI Number: 1073042446
Entity Type: Individual
Name: Wanni Lie
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 8, 2017
Last Updated: Jun 8, 2017

Practice Location

Address: 10870 W CHARLESTON BLVD STE 170
City: Las Vegas
State: Nevada
ZIP Code: 89135-1170
Phone: (702) 254-6412

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X
Dentist - General Practice — General Practice	1223G0001X	Primary

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