Provider Demographics
NPI:1750496600
Name:LIU, DOMINIC POYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOMINIC
Middle Name:POYLE
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 1:1810 BLUE BARN RD
Mailing Address - Street 2:
Mailing Address - City:OREFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:18069-9004
Mailing Address - Country:US
Mailing Address - Phone:610-398-1430
Mailing Address - Fax:610-395-8093
Practice Address - Street 1:1810 BLUE BARN RD
Practice Address - Street 2:
Practice Address - City:OREFIELD
Practice Address - State:PA
Practice Address - Zip Code:18069-9004
Practice Address - Country:US
Practice Address - Phone:610-398-1430
Practice Address - Fax:610-395-8093
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018257L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist