Provider Demographics
NPI:1902006000
Name:LIU, NOEL
Entity Type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3127 N UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-1316
Mailing Address - Country:US
Mailing Address - Phone:309-681-8888
Mailing Address - Fax:
Practice Address - Street 1:3127 N. UNIVERSITY ST.
Practice Address - Street 2:UNIT C
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604
Practice Address - Country:US
Practice Address - Phone:309-681-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037845122300000X
IADDS-09285122300000X
IL19027468122300000X
IN12013063A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist