Individual
DR. GREGG A LIEDTKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
605 S COOLIDGE ST, MOSES LAKE, WA 98837
(509) 765-0674
(506) 765-6591
Mailing address
2034 E 63RD AVE, SPOKANE, WA 99223-8436
(509) 855-3946
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE00010090
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5048210
—
WA
Enumeration date
11/29/2006
Last updated
06/21/2018
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