Eric P. Liedtke, D.D.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

021001663 Issued in IL

Practice address

6855 S 27TH St
Franklin, WI 53132-8045

Phone

(414) 435-0787

NPI assigned

Dec 5, 2006

Sex

Male

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Associates LTD of Wisconsin

  • Endodontics
  • Wauwatosa, WI
  • NPI 1518266998

  Orthodontics and Dentofacial Orthopedics

  NPD
• Stat Anesthesia Specialists, LTD.

  • Anesthesiology Physician
  • Bremen, IN
  • NPI 1992754089
  NPD (past)

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700179200000",
    "number": "1245398924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 W BURLEIGH ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532223196",
            "telephone_number": "414-771-2345",
            "fax_number": "630-904-3963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6855 S 27TH ST",
            "city": "FRANKLIN",
            "state": "WI",
            "postal_code": "531328045",
            "telephone_number": "414-435-0787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEDTKE",
        "first_name": "ERIC",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WI",
            "license": "1001971",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IL",
            "license": "021001663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly DG Leon, MS RD CD
• Travis Lepera, DMD, MA
• Chloe Leszczynski, DPT
• Belinda V Leung, MD
• Lauren Lieb, LCSW
• Emily Liewen
• Kimberly J Little, M.D.
• Miaja Longoria
• Loomis Road Dental Center LLC
• Miles M Loosemore, DC

• Orthodontics and Dentofacial Orthopedics Dentistry in Franklin, WI
• Providers in Franklin, WI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2023; 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.