Healthcare Provider Details

I. General information

NPI: 1154321081
Provider Name (Legal Business Name): SUE-CHIN LIU, DMD, PHD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15160 NW LAIDLAW RD SUITE 200
PORTLAND OR
97229-7707
US

IV. Provider business mailing address

15160 NW LAIDLAW RD SUITE 200
PORTLAND OR
97229-7707
US

V. Phone/Fax

Practice location:
  • Phone: 503-614-8898
  • Fax: 503-690-9072
Mailing address:
  • Phone: 503-614-8898
  • Fax: 503-690-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD7125
License Number StateOR

VIII. Authorized Official

Name: DR. SUE-CHIN LIU
Title or Position: PRESIDENT
Credential: DMD PHD
Phone: 503-614-8898