Provider Demographics
NPI:1801819453
Name:LIU, EDWARD C (DDS PLLC)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:C
Last Name:LIU
Suffix:
Gender:M
Credentials:DDS PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 NORTH AURELIUS RD
Mailing Address - Street 2:
Mailing Address - City:HOLT
Mailing Address - State:MI
Mailing Address - Zip Code:48842
Mailing Address - Country:US
Mailing Address - Phone:517-699-2985
Mailing Address - Fax:517-699-2205
Practice Address - Street 1:2123 AURELIUS RD
Practice Address - Street 2:
Practice Address - City:HOLT
Practice Address - State:MI
Practice Address - Zip Code:48842-1333
Practice Address - Country:US
Practice Address - Phone:517-699-2985
Practice Address - Fax:517-699-2205
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1800001223G0001X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223G0001XDental ProvidersDentistGeneral Practice