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General NPI Number Information
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NPI Number | 1427550078
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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 | 02/28/2018
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 810 OFALLON RD STE 80
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City | WELDON SPRING
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State | MO
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Zip | 63304-8107
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Country | US
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Telephone | 636-244-4052
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Fax |
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Provider Business Mailing Address
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Address Line | 1422 ELBRIDGE PAYNE RD, STE 240
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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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 | CREDENTIALING SPECIALIST
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Name | ASHLY KRISTINE SUNSHINE
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Credential |
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Telephone | 314-413-2803
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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 | 2000164557
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License Number State | MO
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