Healthcare Provider Details

I. General information

NPI: 1467535864
Provider Name (Legal Business Name): RICHARD YEN-TSAI LIU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SHATTUCK WAY STE 5
NEWINGTON NH
03801-7876
US

IV. Provider business mailing address

101 SHATTUCK WAY #5
NEWINGTON NH
03801
US

V. Phone/Fax

Practice location:
  • Phone: 603-436-9200
  • Fax: 603-436-9219
Mailing address:
  • Phone: 603-436-9200
  • Fax: 603-436-9219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number3078
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number3078
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: