Provider Demographics
NPI:1508014705
Name:LIU, AMBROSE K (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMBROSE
Middle Name:K
Last Name:LIU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLD FARM LN
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1738
Mailing Address - Country:US
Mailing Address - Phone:717-759-8453
Mailing Address - Fax:
Practice Address - Street 1:11 OLD FARM LN
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361
Practice Address - Country:US
Practice Address - Phone:717-759-8453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026301L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice