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General NPI Number Information
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NPI Number | 1790182764
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Entity Type | Individual
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Provider Name | DIANA LIU D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/19/2014
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Last Update Date | 02/18/2016
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Provider Practice Location Address
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Address Line | 445 WATCHUNG AVE
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City | WATCHUNG
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State | NJ
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Zip | 07069-4956
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Country | US
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Telephone | 908-222-0007
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Fax |
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Provider Business Mailing Address
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Address Line | 445 WATCHUNG AVE
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City | WATCHUNG
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State | NJ
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Zip | 07069-4956
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Country | US
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Telephone | 908-222-0007
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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 | 22DI02575700
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 058172
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License Number State | NY
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