Healthcare Provider Details

I. General information

NPI: 1790147791
Provider Name (Legal Business Name): ANN LIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2016
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRY RICH BLVD
SAINT CLAIR PA
17970-1193
US

IV. Provider business mailing address

2933 VAUXHALL RD STE 7 # 1109
VAUXHALL NJ
07088-5656
US

V. Phone/Fax

Practice location:
  • Phone: 570-260-1331
  • Fax:
Mailing address:
  • Phone: 786-475-4367
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI02669100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: