Provider Demographics
NPI:1225283757
Name:ANN D. LIOU, DDS, MSD, PS
Entity Type:Organization
Organization Name:ANN D. LIOU, DDS, MSD, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HECKATHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-776-3166
Mailing Address - Street 1:22815 100TH AVE W
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5919
Mailing Address - Country:US
Mailing Address - Phone:425-776-3166
Mailing Address - Fax:425-776-3881
Practice Address - Street 1:22815 100TH AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5919
Practice Address - Country:US
Practice Address - Phone:425-776-3166
Practice Address - Fax:425-776-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000066291223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1437133774OtherTYPE 1 NPI NUMBER
WA1538244660OtherTYPE 1 NPI NUMBER