Provider Demographics
NPI:1710069992
Name:LIU, TING-TING TINA (DDS)
Entity Type:Individual
Prefix:
First Name:TING-TING TINA
Middle Name:
Last Name:LIU
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 1:4111 194TH ST SW
Mailing Address - Street 2:#201
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036
Mailing Address - Country:US
Mailing Address - Phone:425-835-5204
Mailing Address - Fax:425-835-5205
Practice Address - Street 1:4111 194TH ST SW
Practice Address - Street 2:#201
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036
Practice Address - Country:US
Practice Address - Phone:425-835-5204
Practice Address - Fax:425-835-5205
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009706122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5049234Medicaid