Provider Demographics
NPI:1336999242
Name:LIAO, QIUZHUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:QIUZHUO
Middle Name:
Last Name:LIAO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BROADWAY ST APT 414
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2991
Mailing Address - Country:US
Mailing Address - Phone:804-334-8941
Mailing Address - Fax:
Practice Address - Street 1:806 TUURI PL
Practice Address - Street 2:DEPT OF CHILD & ADOLESCENT DENTISTRY, MOTT CHILDREN'S
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503
Practice Address - Country:US
Practice Address - Phone:810-768-7583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601844122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist