Provider Demographics
NPI:1538516109
Name:LIU SIMMONS, MIN
Entity Type:Individual
Prefix:
First Name:MIN
Middle Name:
Last Name:LIU SIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIN
Other - Middle Name:
Other - Last Name:JIANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:21 SPENCER ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-6317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 TREMONT ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-2654
Practice Address - Country:US
Practice Address - Phone:603-287-1300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04346122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist