NPI 1003269358

Jeremy John Liddiard, DMD

Practitioner Dentist Phoenix, AZ

Practice location

Address: 12005 N Tatum Blvd Suite 105, Phoenix, AZ 85028-1650
Phone: (602) 971-0026

Registered specialties

Dentist Primary

Dental Providers Taxonomy 122300000X Licence D009550 (AZ)

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Registry record

NPI: 1003269358
Entity type: Individual
Sex (as registered): Male
NPI issued: 21 Jul 2016
Record last updated: 21 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.