Healthcare Provider Details

I. General information

NPI: 1629400510
Provider Name (Legal Business Name): QIONG ZHOU LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY LIU DDS

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 10/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 TEAKWOOD LN
EDMOND OK
73013-3721
US

IV. Provider business mailing address

5500 NW EXPRESSWAY STE B
WARR ACRES OK
73132-5218
US

V. Phone/Fax

Practice location:
  • Phone: 405-844-8887
  • Fax: 405-844-9625
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6497
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: