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Provider Information for 1568563021

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. MATTHEW JUSTIN LIAUTAUD DDS

Gender: MALE

Individual NPI: 1568563021

Calendar   Last Updated:  2011-04-28
  Certification Date: 

Details

Name Value
NPI 1568563021
Enumeration Date 2006-09-26
NPI Type 1 - Individual
Sole Proprietor YES
Status Active
Mailing Address 1909 PARKSIDE DR
CONCORD, CA 94519-2525
United States

Phone: 925-687-8250 | Fax: 925-687-8266
View Map External Link
Primary Practice Address 1909 PARKSIDE DR
CONCORD, CA 94519-2525
United States

Phone: 925-687-8250 | Fax: 925-687-8266
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice CA 44732