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General NPI Number Information
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NPI Number | 1013820166
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Entity Type | Organization
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Legal Business Name | SOH OF MISSOURI SAMSON LIU PC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 245 SALT LICK RD
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City | SAINT PETERS
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State | MO
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Zip | 63376-5974
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Country | US
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Telephone | 636-397-1474
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Fax |
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Provider Business Mailing Address
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Address Line | 1190 MERAMEC STATION RD STE 110
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City | BALLWIN
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State | MO
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Zip | 63021-6902
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Country | US
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Telephone | 636-362-4986
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMSON LIU
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Credential |
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Telephone | 217-821-7960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | NULL
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