Healthcare Provider Details

I. General information

NPI: 1073741278
Provider Name (Legal Business Name): XINYAN LIU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 06/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 HANCOCK ST
QUINCY MA
02171-2428
US

IV. Provider business mailing address

145 SOUTH ST
BOSTON MA
02111-2826
US

V. Phone/Fax

Practice location:
  • Phone: 617-745-0280
  • Fax: 617-745-0288
Mailing address:
  • Phone: 617-521-6760
  • Fax: 617-457-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1855149
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: