Provider Demographics
NPI:1437502127
Name:LIU, ELLIE CHEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIE
Middle Name:CHEN
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 1:13500 LYNDHURST ST APT 3050
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-6099
Mailing Address - Country:US
Mailing Address - Phone:669-246-8498
Mailing Address - Fax:
Practice Address - Street 1:507 W STAN SCHLUETER LOOP STE 400
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6877
Practice Address - Country:US
Practice Address - Phone:254-870-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX363591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty