Provider Demographics
NPI:1548987654
Name:SOH OF TEXAS SPECIALTY SERVICES PLLC
Entity type:Organization
Organization Name:SOH OF TEXAS SPECIALTY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-821-7960
Mailing Address - Street 1:1422 ELBRIDGE PAYNE RD STE 240
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-8544
Mailing Address - Country:US
Mailing Address - Phone:636-362-4986
Mailing Address - Fax:
Practice Address - Street 1:2700 BARTON CREEK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-1637
Practice Address - Country:US
Practice Address - Phone:737-203-9006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOH OF TEXAS SPECIALTY SERVICES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty