Provider Demographics
NPI:1649878034
Name:SOH OF MISSOURI SAMSON LIU PC
Entity type:Organization
Organization Name:SOH OF MISSOURI SAMSON LIU PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SAMSON
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-821-7960
Mailing Address - Street 1:810 OFALLON RD STE 70
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-8107
Mailing Address - Country:US
Mailing Address - Phone:636-244-4052
Mailing Address - Fax:
Practice Address - Street 1:810 OFALLON RD STE 70
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-8107
Practice Address - Country:US
Practice Address - Phone:636-244-4052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOH OF MISSOURI SAMSON LIU PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty