Healthcare Provider Details

I. General information

NPI: 1891273488
Provider Name (Legal Business Name): CHI WEI LIU DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2018
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 DOLLEY MADISON RD
GREENSBORO NC
27410-4206
US

IV. Provider business mailing address

3319 RALSTON CT
HIGH POINT NC
27265-9457
US

V. Phone/Fax

Practice location:
  • Phone: 336-854-2990
  • Fax:
Mailing address:
  • Phone: 512-734-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11612
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: