Liedtka, Gregg A
Liedtka, Gregg A is an individual health care provider with primary practice located at 605 S Coolidge St , Moses Lake WA 98837. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Liedtka, Gregg A can be contacted via phone (509) 765-0674.Contact Information
Primary practice address
605 S Coolidge St
Moses Lake WA 98837
Phone: (509) 765-0674
Fax: (506) 765-6591
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | DE00010090 | Washington |
Profile Details
| NPI number | 1619044286 |
|---|---|
| LBN Legal business name | Liedtka, Gregg A |
| Credentials | Doctor of Dental Medicine (DMD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 29th, 2006 |
| Last updated | Jun 21st, 2018 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619044286 | NPPES |
| Washington | MEDICAID | 5048210 |
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