MEDICARE: DR. CHRISTINA LIU D.D.S.

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	1223G0001X	General Practice Dentistry	9958	SC
2	1223G0001X	General Practice Dentistry	044610	NY

General Provider Information

NPI Number	:	1669564019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA LIU D.D.S.

Provider Business Mailing Address
First Line	:	928 EVERGREEN DR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-4803
Country	:	US
Telephone Number	:	516-477-0581
Fax Number	:

Provider Business Practice Location Address
First Line	:	928 EVERGREEN DR
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-4803
Country	:	US
Telephone Number	:	516-477-0581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	12/17/2021

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