Provider Demographics
NPI:1659384840
Name:LIU, SHAOCHEN (DMD)
Entity Type:Individual
Prefix:
First Name:SHAOCHEN
Middle Name:
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 1:101 OLD YORK RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3912
Mailing Address - Country:US
Mailing Address - Phone:215-884-2707
Mailing Address - Fax:215-884-2709
Practice Address - Street 1:101 OLD YORK RD
Practice Address - Street 2:SUITE 401
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046
Practice Address - Country:US
Practice Address - Phone:215-884-2870
Practice Address - Fax:215-884-2709
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA05035017122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018826210001Medicaid