Healthcare Provider Details

I. General information

NPI: 1336999242
Provider Name (Legal Business Name): QIUZHUO LIAO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 S 348TH ST
FEDERAL WAY WA
98003-7021
US

IV. Provider business mailing address

1200 BROADWAY ST APT 414
ANN ARBOR MI
48105-2991
US

V. Phone/Fax

Practice location:
  • Phone: 125-346-5260
  • Fax:
Mailing address:
  • Phone: 804-334-8941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901601844
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number70066668
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: