Healthcare Provider Details

I. General information

NPI: 1659384840
Provider Name (Legal Business Name): SHAOCHEN LIU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 10/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 OLD YORK RD SUITE 401
JENKINTOWN PA
19046
US

IV. Provider business mailing address

101 OLD YORK RD SUITE 401
JENKINTOWN PA
19046-3912
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-2870
  • Fax: 215-884-2709
Mailing address:
  • Phone: 215-884-2707
  • Fax: 215-884-2709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number05035017
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: