Provider Demographics
NPI:1932674330
Name:LIOU, ANDI (DMD)
Entity Type:Individual
Prefix:
First Name:ANDI
Middle Name:
Last Name:LIOU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4625 NE 3RD LN UNIT G4
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5272
Mailing Address - Country:US
Mailing Address - Phone:585-733-3880
Mailing Address - Fax:
Practice Address - Street 1:4625 NE 3RD LN UNIT G4
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5272
Practice Address - Country:US
Practice Address - Phone:585-733-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE608990501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice