Healthcare Provider Details

I. General information

NPI: 1467691378
Provider Name (Legal Business Name): RICK Y. LIEU, D.D.S.,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2009
Last Update Date: 02/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8604 112TH ST E
PUYALLUP WA
98373-3857
US

IV. Provider business mailing address

8604 112TH ST E
PUYALLUP WA
98373-3857
US

V. Phone/Fax

Practice location:
  • Phone: 253-845-0558
  • Fax: 253-841-0980
Mailing address:
  • Phone: 253-845-0558
  • Fax: 253-841-0980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE00008859
License Number StateWA

VIII. Authorized Official

Name: RICK Y LIEU
Title or Position: MEMBER
Credential: D.D.S.
Phone: 253-845-0558