Individual
DR. JOHN DAVID LIEDTKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
593 HWY 59 SOUTH, GARRISON, TX 75996-0905
(936) 347-2163
(936) 347-2088
Mailing address
PO BOX 905, GARRISON, TX 75946-0905
(936) 347-2163
(936) 347-2088
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10424
TX
Other
Enumeration date
09/22/2006
Last updated
07/08/2007
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