Healthcare Provider Details

I. General information

NPI: 1689702607
Provider Name (Legal Business Name): PATRICK LIU D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N MILLER RD SUITE 151
SCOTTSDALE AZ
85251-6431
US

IV. Provider business mailing address

3301 N MILLER RD SUITE 151
SCOTTSDALE AZ
85251-6431
US

V. Phone/Fax

Practice location:
  • Phone: 480-949-5579
  • Fax: 480-949-7309
Mailing address:
  • Phone: 480-949-5579
  • Fax: 480-949-7309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD5080
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: