Most Relevant Information
Provider Data
| NPI Number: | 1003269358 |
| Provider Name: | JEREMY JOHN LIDDIARD D.M.D. |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | D009550 |
Most Important Dates
| Enumeration Date: | 07/21/2016 |
| Last Updated: | 07/21/2016 |
Provider Practice Location
12005 N TATUM BLVD
SUITE 105
PHOENIX
AZ
850281650
Practice Location Phone/Fax
| Phone: | 6029710026 |
| Fax: |
Provider Mailing Location
12005 N TATUM BLVD
SUITE 105
PHOENIX
AZ
850281650
Provider Mailing Phone/Fax
| Phone: | 6029710026 |
| Fax: |