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General NPI Number Information
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NPI Number | 1073214987
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Entity Type | Organization
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Legal Business Name | LIU DENTAL CORPORATION
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 23731 EL TORO RD STE E
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City | LAKE FOREST
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State | CA
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Zip | 92630-8615
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Country | US
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Telephone | 949-910-3551
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Fax |
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Provider Business Mailing Address
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Address Line | 32 BELL CHIME
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City | IRVINE
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State | CA
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Zip | 92618-8804
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA LIU
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Credential |
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Telephone | 949-910-3551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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