Kenneth John Liddiard, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

00203000 Issued in CO

Practice address

2025 W US Highway 50 Ste A100
Pueblo, CO 81008-1571

Phone

(719) 542-2472

Fax

(719) 542-6435

NPI assigned

May 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• North Pueblo Dental Partners

  • Dental Clinic/Center
  • Pueblo, CO
  • NPI 1457506586
  NPD (past)
• Petersen Dental LLC

  • Dentist
  • South Jordan, UT
  • NPI 1417315656
  NPD (past)
• South Jordan PDC PLLC

  • Dentist
  • South Jordan, UT
  • NPI 1336706043
  NPD (past)

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603411200000",
    "number": "1295792307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2025 W US HIGHWAY 50 STE A100",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081571",
            "telephone_number": "719-542-2472",
            "fax_number": "719-542-6435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2025 W US HIGHWAY 50 STE A100",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081571",
            "telephone_number": "719-542-2472",
            "fax_number": "719-542-6435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDDIARD",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00203000",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nia Lewis
• Lynn R Leyba, NP, CNM
• Michael Edward Leyba, MA,LPC,CACIII
• Stephanie Dana Leyba, BA, CACI
• Liberty Dialysis Pueblo LLC
• Alexa Nell Lieb, OTR/L
• John P Lieberman, M.D.
• Dana G Lieser, LPN
• Life Choice Hospice of Colorado II, LLC
• Life Solutions, LLC

• General Practice Dentistry in Pueblo, CO
• Providers in Pueblo, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; 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.