MEDICARE: ESTELLE H. LIOU DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry		CA

General Provider Information

NPI Number	:	1285015321
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTELLE H. LIOU DDS INC

Provider Business Mailing Address
First Line	:	1524 N ORANGE GROVE AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3812
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1524 N ORANGE GROVE AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-3812
Country	:	US
Telephone Number	:	909-623-0583
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ESTELLE LIOU
Credential	:
Telephone Number	:	909-623-0583

Provider Enumeration Date	:	06/15/2015
Last Update Date	:	06/15/2015

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