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General NPI Number Information
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NPI Number | 1336999242
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Entity Type | Individual
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Provider Name | QIUZHUO LIAO DDS
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Gender | Female
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Dates
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Enumeration Date | 03/25/2024
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 806 TUURI PL DEPT OF CHILD & ADOLESCENT DENTISTRY, MOTT CHILDREN'S
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City | FLINT
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State | MI
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Zip | 48503
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Country | US
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Telephone | 810-768-7583
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 BROADWAY ST APT 414
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City | ANN ARBOR
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State | MI
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Zip | 48105-2991
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Country | US
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Telephone | 804-334-8941
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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 | 2901601844
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License Number State | MI
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