Healthcare Provider Details

I. General information

NPI: 1508014705
Provider Name (Legal Business Name): AMBROSE K LIU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 11/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 OLD FARM LN
SHREWSBURY PA
17361
US

IV. Provider business mailing address

11 OLD FARM LN
SHREWSBURY PA
17361-1738
US

V. Phone/Fax

Practice location:
  • Phone: 717-759-8453
  • Fax:
Mailing address:
  • Phone: 717-759-8453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS026301L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: