Provider Demographics
NPI:1750504676
Name:LIU, MICHELE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:
Last Name:LIU
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 1:7139 WESSYNTON DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-7548
Mailing Address - Country:US
Mailing Address - Phone:704-427-0277
Mailing Address - Fax:704-427-0484
Practice Address - Street 1:1525 W WT HARRIS BLVD
Practice Address - Street 2:SUITE 1ANC5903
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28288-0001
Practice Address - Country:US
Practice Address - Phone:704-427-0277
Practice Address - Fax:704-427-0484
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC74551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice