Organization
ALAN LIESINGER DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUSAN LESLIE LIESINGER (OFFICE MANAGER)
(541) 269-2329
Entity
Organization
Contact information
Practice address
375 PARK AVE., SUITE 7, COOS BAY, OR 97420-2242
(541) 267-2329
(541) 267-4026
Mailing address
375 PARK AVE., SUITE 7, COOS BAY, OR 97420-2242
(541) 267-2329
(541) 267-4026
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
667595
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
168369
WELFARE PROVIDER #
—
Enumeration date
09/10/2012
Last updated
09/10/2012
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