Provider Demographics
NPI:1073741278
Name:LIU, XINYAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:XINYAN
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-2826
Mailing Address - Country:US
Mailing Address - Phone:617-521-6760
Mailing Address - Fax:617-457-6696
Practice Address - Street 1:435 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2428
Practice Address - Country:US
Practice Address - Phone:617-745-0280
Practice Address - Fax:617-745-0288
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice