Healthcare Provider Details

I. General information

NPI: 1215110093
Provider Name (Legal Business Name): LIU DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2007
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5527 CLAIREMONT MESA BLVD
SAN DIEGO CA
92117-2342
US

IV. Provider business mailing address

5527 CLAIREMONT MESA BLVD
SAN DIEGO CA
92117-2342
US

V. Phone/Fax

Practice location:
  • Phone: 858-467-0503
  • Fax: 858-467-9103
Mailing address:
  • Phone: 858-467-0503
  • Fax: 858-467-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number41461
License Number StateCA

VIII. Authorized Official

Name: DR. MOLLY S LIU
Title or Position: PRESIDENT
Credential: DDS
Phone: 858-467-0503