Provider Demographics
NPI:1205051737
Name:LINDA LIU DMD, PC
Entity type:Organization
Organization Name:LINDA LIU DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LIDONG
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-878-5828
Mailing Address - Street 1:14377 WOODLAKE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5735
Mailing Address - Country:US
Mailing Address - Phone:314-878-5828
Mailing Address - Fax:314-878-5828
Practice Address - Street 1:14377 WOODLAKE DR STE 310
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5735
Practice Address - Country:US
Practice Address - Phone:314-878-5828
Practice Address - Fax:314-878-5828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010184881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty