Wanni Lie

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6920 Issued in NV

Practice address

10870 W Charleston Blvd Ste 170
Las Vegas, NV 89135-1170

Phone

(702) 254-6412

NPI assigned

Jun 8, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Khakwani Medical Corporation, PC

  • Family Medicine Physician
  • Las Vegas, NV
  • NPI 1396190716
  NPD (past)
• Shahrestani Canyon Pointe Dental Group PC

  • General Practice Dentistry
  • Las Vegas, NV
  • NPI 1750571535
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496880000000",
    "number": "1073042446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 TRUETT ST UNIT 101",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891288074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10870 W CHARLESTON BLVD STE 170",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891351170",
            "telephone_number": "702-254-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIE",
        "first_name": "WANNI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-08",
        "last_updated": "2017-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "6920",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "6920",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Lide
• J'Ree J'Nel Lide
• Julie Marie Woods Lide, PA-C
• Takar Lide
• Lie Charleston Smiles Dentistry, PC
• Richard D Lieber, MD
• Douglas Jason Lieberman
• Rebecca A Liebert, APN
• Jonathan T Liebig, M.D.
• Michelle Lieder

• General Practice Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.