Provider Demographics
NPI:1497868350
Name:LIU, LIDONG LINDA (DMD)
Entity Type:Individual
Prefix:
First Name:LIDONG
Middle Name:LINDA
Last Name:LIU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:14377 WOODLAKE DR
Mailing Address - Street 2:STE 310
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-878-5828
Mailing Address - Fax:314-878-5828
Practice Address - Street 1:14377 WOODLAKE DR
Practice Address - Street 2:STE 310
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-878-5828
Practice Address - Fax:314-878-5828
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018488122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist