Provider Demographics
NPI:1457672776
Name:LIVINGSTON, ERIC S (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:S
Last Name:LIVINGSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 W KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-2263
Mailing Address - Country:US
Mailing Address - Phone:816-781-1224
Mailing Address - Fax:
Practice Address - Street 1:1129 W KANSAS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-2263
Practice Address - Country:US
Practice Address - Phone:816-781-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009014028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist