=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922847888
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL TINGJIUN LIU DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2024
-----------------------------------------------------
Last Update Date | 05/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21 CORPORATE DR STE 1
-----------------------------------------------------
City | EASTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18045-2664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-258-4379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 VIOLA TER
-----------------------------------------------------
City | TOWNSHIP OF WASHINGTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07676-4754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 551-206-2052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number | DS044582
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------