Provider Demographics
NPI:1528427721
Name:LIU, WINSTON
Entity type:Individual
Prefix:
First Name:WINSTON
Middle Name:
Last Name:LIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 OLSON MEMORIAL HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-0717
Mailing Address - Country:US
Mailing Address - Phone:763-544-0121
Mailing Address - Fax:
Practice Address - Street 1:4800 OLSON MEMORIAL HWY STE 110
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-0717
Practice Address - Country:US
Practice Address - Phone:763-544-0121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND138601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice