Individual
DR. JEREMY JOHN LIDDIARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
12005 N TATUM BLVD, SUITE 105, PHOENIX, AZ 85028-1650
(602) 971-0026
Mailing address
12005 N TATUM BLVD, SUITE 105, PHOENIX, AZ 85028-1650
(602) 971-0026
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D009550
AZ
Other
Enumeration date
07/21/2016
Last updated
07/21/2016
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