Basic Information
| Provider Information | |||||||||
| NPI: | 1801419973 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LIU | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | HAOYU | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 143 FLORENDIN DR | ||||||||
| Address2: | |||||||||
| City: | HENRIETTA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144679218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5857529968 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4494 NORTH PALMER ROAD | ||||||||
| Address2: | |||||||||
| City: | BETHESDA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208890001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3012954000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2020 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 11839372-9921 | UT | Y | Dental Providers | Dentist | General Practice |
No ID Information.