Healthcare Provider Details

I. General information

NPI: 1255059044
Provider Name (Legal Business Name): XIE & LIU DENTAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2022
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 PACIFICA STE 350
IRVINE CA
92618-3335
US

IV. Provider business mailing address

24970 KEISSEL RD
COLTON CA
92324-9687
US

V. Phone/Fax

Practice location:
  • Phone: 909-247-4258
  • Fax:
Mailing address:
  • Phone: 909-247-4258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY LIU
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 909-247-4258