Provider Demographics
NPI:1427520790
Name:SOH OF TEXAS SAMSON LIU PLLC
Entity type:Organization
Organization Name:SOH OF TEXAS SAMSON LIU PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ASHLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNSHINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-362-4986
Mailing Address - Street 1:4206 LOWES DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-3498
Mailing Address - Country:US
Mailing Address - Phone:254-778-5070
Mailing Address - Fax:254-771-0235
Practice Address - Street 1:4206 LOWES DR
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-3498
Practice Address - Country:US
Practice Address - Phone:254-778-5070
Practice Address - Fax:254-771-0235
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOH OF TEXAS SAMSON LIU PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-26
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty