Jessica R Liu, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D011827 Issued in AZ

Practice address

1501 N Arizona Blvd
Coolidge, AZ 85128-3215

Phone

(520) 723-1700

NPI assigned

Jul 7, 2022

Last updated

Apr 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1396478228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 N ARIZONA BLVD",
            "city": "COOLIDGE",
            "state": "AZ",
            "postal_code": "851283215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 N ARIZONA BLVD",
            "city": "COOLIDGE",
            "state": "AZ",
            "postal_code": "851283215",
            "telephone_number": "520-723-1700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3710 SW US Veterans Hospital Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972392964",
            "country_code": "US",
            "telephone_number": "503-220-8262",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LIU",
        "first_name": "JESSICA",
        "middle_name": "R",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-07",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D011827",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OR",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rasha Kumar, OPTOMETRIST OD
• Taylor Larue
• Taylor Lauren Lavender, DMD
• Laura Grace Lew, R.N.
• Rina Li
• Jamie Logsdon, PHARMD
• Ramon Angel Lopez, CEO
• Lucyrenes Care Homes
• Mark W. Lutz, LPC
• Renal Selwayn McBean Sr., M.A.COUNSELING

• General Practice Dentistry in Coolidge, AZ
• Providers in Coolidge, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.