Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0221X | Pediatric Dentist | 35803 | TX |
N | 1223P0221X | Pediatric Dentist | D010515 | AZ |
Y | 1223P0221X | Pediatric Dentist | DN23996 | FL |
NPI | 1043665227 |
---|---|
Provider Name | Dr. Tong Liu |
First Address | Toledo, OH 43614-2595 |
Second Address | Fort Myers, FL 33907 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2016 |
Last Update Date | 27/02/2020 |