Provider Demographics
NPI:1902012388
Name:LIU, GRACE I (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:I
Last Name:LIU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:I-YIN
Other - Middle Name:
Other - Last Name:LIU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:17 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-1111
Mailing Address - Country:US
Mailing Address - Phone:302-514-6200
Mailing Address - Fax:
Practice Address - Street 1:17 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1111
Practice Address - Country:US
Practice Address - Phone:302-514-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00011471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice