Individual
NICHOLAS LIEB
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
47 CRESTWOOD RD, KAYSVILLE, UT 84037-1445
(801) 546-2439
Mailing address
47 CRESTWOOD RD, KAYSVILLE, UT 84037-1445
(801) 546-2439
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10766525-9923
UT
1223G0001X
General Practice Dentistry
DS039709
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/07/2013
Last updated
10/25/2023
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