Provider Demographics
NPI:1366901951
Name:LIU, NICOLE CHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CHEN
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 1:127 GREYROCK PL
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3100
Mailing Address - Country:US
Mailing Address - Phone:209-915-4744
Mailing Address - Fax:
Practice Address - Street 1:127 GREYROCK PL
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3100
Practice Address - Country:US
Practice Address - Phone:209-915-4744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0614981223X0400X
CT138201223X0400X
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics