John David Liedtke, DDS
Individual provider Active NPI Dentist · Garrison, TX
NPI 1811096282 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811096282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 10424 (TX)
- Practice address
- 593 Hwy 59 South
Garrison, TX 75996-0905 - Phone
- (936) 347-2163
- Fax
- (936) 347-2088
- NPI assigned
- Sep 22, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10424 | TX | Yes |
Addresses
Primary practice location
593 Hwy 59 South
Garrison, TX 75996-0905
Mailing address
PO Box 905
Garrison, TX 75946-0905
Phone (936) 347-2163
Other providers in Garrison, TX
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.