Provider Demographics
NPI:1124656244
Name:LIU, SHIMU (DMD)
Entity type:Individual
Prefix:
First Name:SHIMU
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8181 FANNIN ST APT 614
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2915
Mailing Address - Country:US
Mailing Address - Phone:267-585-4204
Mailing Address - Fax:
Practice Address - Street 1:16261 FM 529 RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-1433
Practice Address - Country:US
Practice Address - Phone:281-200-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35362122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist