Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 6123 | NE |
NPI | 1003806878 |
---|---|
Provider Name | Matthew M Liebentritt |
First Address | Springfield, NE 68059-0328 |
Second Address | Springfield, NE 68059-0328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 08/07/2007 |