Provider Demographics
NPI:1811057284
Name:LLOYD K. LIU DMD, PC
Entity type:Organization
Organization Name:LLOYD K. LIU DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:K
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-553-2588
Mailing Address - Street 1:432 EAST 12300 SOUTH
Mailing Address - Street 2:SUITE 8
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020
Mailing Address - Country:US
Mailing Address - Phone:801-553-2588
Mailing Address - Fax:801-553-2100
Practice Address - Street 1:432 EAST 12300 SOUTH
Practice Address - Street 2:SUITE 8
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020
Practice Address - Country:US
Practice Address - Phone:801-553-2588
Practice Address - Fax:801-553-2100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89-144630-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT789803OtherUNITED CONCORDIA TRICARE
UT144630OtherDELTA DENTAL
UT528904611024Medicaid