Provider Demographics
NPI:1821142522
Name:LIU, ISAAC NK (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:NK
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 1:14605 GLAZIER AVE
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-7545
Mailing Address - Country:US
Mailing Address - Phone:952-432-1103
Mailing Address - Fax:
Practice Address - Street 1:200 COON RAPIDS BLVD NW
Practice Address - Street 2:220
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5876
Practice Address - Country:US
Practice Address - Phone:763-786-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN108791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics