Provider Demographics
NPI:1184798399
Name:LIU, LLOYD K (DMD)
Entity type:Individual
Prefix:DR
First Name:LLOYD
Middle Name:K
Last Name:LIU
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 1:432 E 12300 S
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9503
Mailing Address - Country:US
Mailing Address - Phone:801-553-2588
Mailing Address - Fax:801-553-2100
Practice Address - Street 1:432 E 12300 S
Practice Address - Street 2:SUITE 8
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9503
Practice Address - Country:US
Practice Address - Phone:801-553-2588
Practice Address - Fax:801-553-2100
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89-144630-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT789803OtherUNITED CONCORDIA
UT144630OtherDELTA DENTAL