Gregg A Liedtka, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE00010090 Issued in WA

Practice address

605 S Coolidge St
Moses Lake, WA 98837

Phone

(509) 765-0674

Fax

(506) 765-6591

NPI assigned

Nov 29, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Department of Social Dept of SHS Div of Instns

  • Psychiatric Hospital
  • Medical Lake, WA
  • NPI 1467440602
  Medicare reassignment NPD
• Lincoln County Public Hospital District 1

  • Critical Access Hospital
  • Odessa, WA
  • NPI 1073524690
  NPD (past)

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529539200000",
    "number": "1619044286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2034 E 63RD AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992238436",
            "telephone_number": "509-855-3946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "98837",
            "telephone_number": "509-765-0674",
            "fax_number": "506-765-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIEDTKA",
        "first_name": "GREGG",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-29",
        "last_updated": "2018-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00010090",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5048210",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corey Levi, LMT
• Christiian T Lewis, ARNP
• Erin K Lewis, PT
• Ioly Tabita Lewis, PMHNP/ARNP
• Liberty Enterprises, LLC
• Life Wellness Chiropractic LLC
• Lightening the Load Counseling PLLC
• Karen M Lindberg, MD
• Cinthia Mabel Llamas
• Sara Lynn Logan, DDS

• General Practice Dentistry in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.