Provider Demographics
NPI:1326359266
Name:LIU, MILTON JASON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILTON
Middle Name:JASON
Last Name:LIU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-4008
Mailing Address - Country:US
Mailing Address - Phone:401-729-5239
Mailing Address - Fax:401-312-2011
Practice Address - Street 1:210 MAIN ST
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-4008
Practice Address - Country:US
Practice Address - Phone:401-729-5239
Practice Address - Fax:401-312-2011
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15330122300000X
RILD00055122300000X
RIDEN03122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist