Healthcare Provider Details

I. General information

NPI: 1225283757
Provider Name (Legal Business Name): ANN D. LIOU, DDS, MSD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22815 100TH AVE W
EDMONDS WA
98020-5919
US

IV. Provider business mailing address

22815 100TH AVE W
EDMONDS WA
98020-5919
US

V. Phone/Fax

Practice location:
  • Phone: 425-776-3166
  • Fax: 425-776-3881
Mailing address:
  • Phone: 425-776-3166
  • Fax: 425-776-3881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00006629
License Number StateWA

VIII. Authorized Official

Name: MS. BRENDA LYNN HECKATHORN
Title or Position: OFFICE MANAGER
Credential:
Phone: 425-776-3166