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General NPI Number Information
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NPI Number | 1306903471
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Entity Type | Individual
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Provider Name | CONNIE LIU D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3708 MAIN ST 4TH FLOOR
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City | FLUSHING
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State | NY
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Zip | 11354-6509
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Country | US
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Telephone | 718-886-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 322 W 55TH ST APT# 2B
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City | NEW YORK
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State | NY
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Zip | 10019-5157
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Country | US
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Telephone | 917-609-2735
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 051204
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License Number State | NY
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