Provider Demographics
NPI:1689885477
Name:ROBERTS AND LIU DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:ROBERTS AND LIU DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BING
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-583-1218
Mailing Address - Street 1:556 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2515
Mailing Address - Country:US
Mailing Address - Phone:508-583-1218
Mailing Address - Fax:
Practice Address - Street 1:556 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2515
Practice Address - Country:US
Practice Address - Phone:508-583-1218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20796122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA20796OtherDENTAL LICENSE
MA21557OtherDENTAL LICENSE
MA14225OtherDENTAL LICENSE