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General NPI Number Information
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NPI Number | 1245695311
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Entity Type | Organization
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Legal Business Name | EDWARD S. LIU, DDS, INC.
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Dates
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Enumeration Date | 12/16/2015
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Last Update Date | 12/16/2015
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Provider Practice Location Address
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Address Line | 8884 KNOTT AVE
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City | BUENA PARK
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State | CA
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Zip | 90620-4135
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Country | US
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Telephone | 714-995-5000
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Fax | 714-995-5125
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Provider Business Mailing Address
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Address Line | 8884 KNOTT AVE
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City | BUENA PARK
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State | CA
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Zip | 90620-4135
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Country | US
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Telephone | 714-995-5000
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Fax | 714-995-5125
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD SHIH LIU
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Credential | DDS
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Telephone | 626-625-5570
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54529
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License Number State | CA
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