Provider Demographics
NPI:1972584068
Name:LIU, PEIXIN (DDS)
Entity Type:Individual
Prefix:
First Name:PEIXIN
Middle Name:
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 1:500 OSBORNE RD NE
Mailing Address - Street 2:STE 155 UNITY PROFESSIONAL BUILDING
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432
Mailing Address - Country:US
Mailing Address - Phone:763-786-3800
Mailing Address - Fax:763-786-9508
Practice Address - Street 1:500 OSBORNE RD NE
Practice Address - Street 2:STE 155 UNITY PROFESSIONAL BUILDING
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-786-3800
Practice Address - Fax:763-786-9508
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND112321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice