Provider Demographics
NPI:1013113067
Name:DR. NATHANIEL S. LIU, DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DR. NATHANIEL S. LIU, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-259-4001
Mailing Address - Street 1:28350 VIA SANTA ROSA
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5335
Mailing Address - Country:US
Mailing Address - Phone:619-259-4001
Mailing Address - Fax:619-393-0413
Practice Address - Street 1:28350 VIA SANTA ROSA
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5335
Practice Address - Country:US
Practice Address - Phone:619-259-4001
Practice Address - Fax:619-393-0413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA994241223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9818801OtherDELTA DENTAL
CAG9242601Medicaid
CA924775OtherUNITED CONCORDIA