Healthcare Provider Details

I. General information

NPI: 1013820166
Provider Name (Legal Business Name): SOH OF MISSOURI SAMSON LIU PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 SALT LICK RD
SAINT PETERS MO
63376-5974
US

IV. Provider business mailing address

1190 MERAMEC STATION RD STE 110
BALLWIN MO
63021-6902
US

V. Phone/Fax

Practice location:
  • Phone: 636-397-1474
  • Fax:
Mailing address:
  • Phone: 636-362-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAMSON LIU
Title or Position: OWNER
Credential:
Phone: 217-821-7960