Healthcare Provider Details

I. General information

NPI: 1003981259
Provider Name (Legal Business Name): RICHARD Y LIU DMD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/27/2010
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 STE 5
NEWINGTON NH
03801-7876
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 Code1223P0700X
TaxonomyProsthodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3078
License Number StateNH

VIII. Authorized Official

Name: DR. RICHARD Y LIU
Title or Position: PRESIDENT
Credential: DMD MMS
Phone: 603-436-9200