Provider Demographics
NPI:1568501955
Name:LIU, SAMSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMSON
Middle Name:
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 1:1422 ELBRIDGE PAYNE RD, STE 240
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1138
Mailing Address - Country:US
Mailing Address - Phone:636-362-4986
Mailing Address - Fax:636-778-1344
Practice Address - Street 1:810 O'FALLON RD
Practice Address - Street 2:
Practice Address - City:WELDON SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:63304-6330
Practice Address - Country:US
Practice Address - Phone:636-244-4052
Practice Address - Fax:636-244-3850
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200164557122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO405172701Medicaid