Healthcare Provider Details

I. General information

NPI: 1922847888
Provider Name (Legal Business Name): CAROL TINGJIUN LIU DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 CORPORATE DR STE 1
EASTON PA
18045-2664
US

IV. Provider business mailing address

21 VIOLA TER
TOWNSHIP OF WASHINGTON NJ
07676-4754
US

V. Phone/Fax

Practice location:
  • Phone: 610-258-4379
  • Fax:
Mailing address:
  • Phone: 551-206-2052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDS044582
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: