John Paul Livengood, D.M.D.
Individual provider Active NPI General Practice Dentistry · Bedford, AL
NPI 1356366157 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1356366157
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- DS017695 (PA)
- Practice address
- 125 Back Springs Rd
Bedford, AL 15522 - Phone
- (814) 623-5513
- Fax
- (814) 623-8147
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS017695 | PA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS017695 | PA | Yes |
Addresses
Primary practice location
125 Back Springs Rd
Bedford, AL 15522
Mailing address
125 Back Springs Rd
Bedford, PA 15522-2040
Phone (814) 623-5513
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 148027 | Other | PA | UNITED CONCORDIA |
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.