Active NPI
Justin William Liska, D.D.S.
- Oral and Maxillofacial Surgery (Dentist)
- Conroe, TX
National Provider Identifier
1912290453
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 31680
- Practice address
- 2249 N Loop 336 W
Suite a
Conroe, TX 77304-3639 - Phone
- (936) 441-8180
- Fax
- (936) 441-1905
- NPI assigned
- May 17, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 31680 | TX | Primary |
Addresses
Primary practice location
2249 N Loop 336 W
Suite a
Conroe, TX 77304-3639
Mailing address
2249 N Loop 336 W
Suite a
Conroe, TX 77304-3639
Phone (713) 542-7001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 24, 2016 through Mar 24, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31680 | TX | MD | Oral and Maxillofacial Surgery (Dentist) |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472515200000",
"number": "1912290453",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2249 N LOOP 336 W",
"address_2": "SUITE A",
"city": "CONROE",
"state": "TX",
"postal_code": "773043639",
"telephone_number": "713-542-7001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2249 N LOOP 336 W",
"address_2": "SUITE A",
"city": "CONROE",
"state": "TX",
"postal_code": "773043639",
"telephone_number": "936-441-8180",
"fax_number": "936-441-1905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LISKA",
"first_name": "JUSTIN",
"middle_name": "WILLIAM",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-17",
"last_updated": "2016-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "TX",
"license": "31680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Conroe, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.