Healthcare Provider Details

I. General information

NPI: 1750837829
Provider Name (Legal Business Name): JESSICA LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 S BERETANIA ST STE 575
HONOLULU HI
96814
US

IV. Provider business mailing address

1401 S BERETANIA ST STE 575
HONOLULU HI
96814-1879
US

V. Phone/Fax

Practice location:
  • Phone: 808-218-6650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDT-2717
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: