Individual
CHARLES(CHIAHO) LIU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2558 W 4TH ST, ONTARIO, OH 44906-1209
(419) 683-3131
Mailing address
2558 W 4TH ST, ONTARIO, OH 44906-1209
(419) 683-3131
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-02-20402
OH
332B00000X
Durable Medical Equipment & Medical Supplies
20402
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0199404
—
OH
Enumeration date
07/11/2006
Last updated
12/03/2018
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