Provider Demographics
NPI:1093842841
Name:PEIXIN LIU DDS
Entity Type:Organization
Organization Name:PEIXIN LIU DDS
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:763-786-3800
Mailing Address - Street 1:2407 109TH AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449
Mailing Address - Country:US
Mailing Address - Phone:763-783-8200
Mailing Address - Fax:763-783-7197
Practice Address - Street 1:2407 109TH AVENUE
Practice Address - Street 2:SUITE 240
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449
Practice Address - Country:US
Practice Address - Phone:763-783-8200
Practice Address - Fax:763-783-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND11232MN1223G0001X
MND12319MN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1972584068OtherNPI
MND11232OtherLICENSE
MND12319OtherLICENSE
1760540942OtherNPI