Provider Demographics
NPI:1588840235
Name:XU, NA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NA
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4392 LIBERTY RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-6171
Mailing Address - Country:US
Mailing Address - Phone:503-315-2500
Mailing Address - Fax:541-924-1174
Practice Address - Street 1:4392 LIBERTY RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-6171
Practice Address - Country:US
Practice Address - Phone:503-315-2500
Practice Address - Fax:503-339-1981
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD8941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist