Healthcare Provider Details

I. General information

NPI: 1487451076
Provider Name (Legal Business Name): SUSAN TINA LIU PHARMD, DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S STATE RD STE 300
SPRINGFIELD PA
19064-1232
US

IV. Provider business mailing address

19 COUNTRY SQUIRE LN
HOLMDEL NJ
07733-2369
US

V. Phone/Fax

Practice location:
  • Phone: 610-622-1949
  • Fax:
Mailing address:
  • Phone: 732-947-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS044805
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: