Healthcare Provider Details

I. General information

NPI: 1205079449
Provider Name (Legal Business Name): PAMELA LIU D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2009
Last Update Date: 04/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 HILLSIDE AVE
JAMAICA NY
11432-3216
US

IV. Provider business mailing address

1 MIRRIELEES RD
GREAT NECK NY
11021-2927
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-1111
  • Fax:
Mailing address:
  • Phone: 516-482-7903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number054326
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: