Andrew Carl Lidral, DDS PHD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

21447 Issued in MI

Practice address

158 Marcell Dr NE
Rockford, MI 49341

Phone

(616) 866-8010

Fax

(616) 866-7401

NPI assigned

Sep 11, 2006

Sex

Male

Sole proprietor

No

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)

Enrolled

Credentials

Doctor of Philosophy

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.

• Mark P. Brieden D.D.S., M.S., P.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Rockford, MI
  • NPI 1508845918
  NPD (past)

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571011200000",
    "number": "1306940317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 MARCELL DR NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-8010",
            "fax_number": "616-866-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 MARCELL DR NE",
            "city": "ROCKFORD",
            "state": "MI",
            "postal_code": "49341",
            "telephone_number": "616-866-8010",
            "fax_number": "616-866-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIDRAL",
        "first_name": "ANDREW",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "DDS PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IA",
            "license": "07539",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MI",
            "license": "21447",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kendra Grace Leep
• Theresa Lesarge, BSW
• Madison Levine
• Colleen Pollock Lewis, M.S. CCC-SLP
• Karen E Lewis, M.S.
• Camden Jaye Lieberman
• Cynthia Lieske
• Life Beyond Barriers Rehabilitation
• Lifetime Dental Care of Michigan, P.C.
• Jayme Lindgren

• Orthodontics and Dentofacial Orthopedics Dentistry in Rockford, MI
• Providers in Rockford, MI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2019; 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.