Provider Demographics
NPI:1801359880
Name:SOH OF TEXAS SAMSON LIU PLLC
Entity Type:Organization
Organization Name:SOH OF TEXAS SAMSON LIU PLLC
Other - Org Name:THE COSMETIC DENTIST OF AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VENDOR RELATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNSHINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-362-4986
Mailing Address - Street 1:2700 BARTON CREEK BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78735-1637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 BARTON CREEK BLVD STE 130
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-1637
Practice Address - Country:US
Practice Address - Phone:512-333-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty