Zhenyu Liang, D.D.S.
Individual provider Active NPI Dentist · Fennimore, WI
NPI 1073806014 · NPPES record last updated Aug 21, 2014
Key facts
- NPI
- 1073806014
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 6808-15 (WI)
- Practice address
- 220 Lincoln Ave
Fennimore, WI 53809-1036 - Phone
- (608) 822-3770
- NPI assigned
- May 24, 2011
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150126000416 | WI | Order and Referring Only - Dentist |
3870817760 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6808-15 | WI | MD | Dentist |
| 055519-1 | NY | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 055519-1 | NY | |
| Dentist | 122300000X | 6808-15 | WI | Yes |
Addresses
Primary practice location
220 Lincoln Ave
Fennimore, WI 53809-1036
Mailing address
301 Harbour Town Dr
Apt #211
Madison, WI 53717-2110
Phone (608) 466-0608
Other providers in Fennimore, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.