Provider Demographics
NPI:1225502362
Name:LIEBENTRITT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LIEBENTRITT FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBENTRITT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-253-2868
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NE
Mailing Address - Zip Code:68059
Mailing Address - Country:US
Mailing Address - Phone:402-253-2868
Mailing Address - Fax:402-253-2881
Practice Address - Street 1:191 MAIN ST.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NE
Practice Address - Zip Code:68059
Practice Address - Country:US
Practice Address - Phone:402-253-2868
Practice Address - Fax:402-253-2881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty